Overuse of abdominopelvic CT in pediatric emergencies: a large single-center study from a middle eastern tertiary...

Abdominopelvic CT scans are widely used in pediatric emergency departments (PEDs) but are frequently overused, often resulting in a high proportion of normal findings. To evaluate the diagnostic utility of abdominopelvic CT in acute pediatric emergencies and to identify patterns of use and potential overuse, particularly in relation to presenting symptoms and clinical context. This retrospective study of 399 children (56.6% male, mean age 6.54 ± 4.0 years) at a tertiary center in Tehran, Iran (2021), evaluated the diagnostic utility of abdominopelvic CT in acute pediatric emergencies. Abdominal pain was the most common symptom (46.9%), followed by diarrhea/vomiting (13.0%) and trauma (8.8%). Common CT diagnoses included mesenteric adenitis (8.5%), abdominal mass (7.5%), and appendicitis (6.0%), while nearly one-quarter of examinations (23.8%) demonstrated normal findings. Abdominal pain strongly predicted appendicitis (NPV 96.7%, sensitivity 89.5%, OR 10.87, 95% CI 4.12-28.67) and mesenteric adenitis (NPV 93.9%, sensitivity 80.9%, OR 5.44, 95% CI 2.31-12.82). Trauma cases exhibited the highest proportion of normal CT findings (74.3%), particularly among hemodynamically stable patients. Conclusion: While abdominopelvic CT remains valuable in selected pediatric abdominal emergencies, particularly in high-risk clinical scenarios, the high proportion of normal examinations-especially in trauma cases-highlights the need for more selective CT utilization. These findings support the adoption of ultrasound-first approaches, structured clinical decision-making tools, and locally adapted imaging guidelines to minimize unnecessary radiation exposure in pediatric patients, particularly in resource-limited settings.