ACR Appropriateness Criteria® Gastrointestinal Bleeding-Child

Gastrointestinal (GI) bleeding is a relatively common presenting complaint in pediatric practices and may arise from either the upper or lower GI tract. Many common causes of GI bleed are benign and self-limited, often requiring only supportive care with no imaging necessary. When indicated, the goal of imaging is to diagnose and localize the source of bleeding to help guide timely, targeted interventions. Abdominal radiography is often the initial imaging study obtained for patients presenting with GI bleeding. Although it is usually unable to precisely localize the site of bleeding, it may provide clues to the diagnosis. Nuclear medicine imaging studies including pertechnetate (Meckel scan) and tagged red blood cell studies can help localize the site of bleeding, occasionally providing a specific diagnosis. CT angiography of the abdomen and pelvis may be appropriate in many scenarios; however, in unstable patients CT angiography is usually appropriate as initial imaging. Visceral angiography may also be used. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.