Plain abdominal radiography in the detection of major disease in children: A prospective analysis

doi:10.1016/S0196-0644(05)80053-8

Annals of Emergency Medicine

Volume 21, Issue 12, December 1992, Pages 1423-1429

https://doi.org/10.1016/S0196-0644(05)80053-8 Get rights and content

Study objective:

To prospectively evaluate previously described high-yield clinical criteria for obtaining plain abdominal radiographs in the emergency evaluation of children.

Design:

Prospective, observational study.

Setting:

Emergency departments of a university medical center and an affiliated county hospital.

Participants:

Three hundred fifty-four children 15 years old or younger who underwent plain abdominal radiography during a one-year period.

Methods and measurements:

Physicians ordering plain abdominal radiographs completed data forms that included historical and physical examination information before viewing films. At a later date, records of all patients were reviewed for radiologist interpretation and final diagnosis. The data were analyzed to determine the sensitivity, specificity, and predictive values of previously described high-yield criteria (from a retrospective series) in detecting radiographs that were diagnostic or suggestive of “major” abdominal disease.

Main results:

Sixty-one patients (17%) had major diseases potentially requiring procedural intervention (eg, appendicitis, ingested foreign bodies, and intussusception), whereas 296 patients (83%) had minor diseases not requiring procedural intervention (eg, gastroenteritis and nonabdominal diagnoses). The presence of any of the following features—prior abdominal surgery, foreign body ingestion, abnormal bowel sounds, abdominal distention, or peritoneal signs—was 93% sensitive and 40% specific in detecting diagnostic or suggestive radiographs in patients with major disease. Positive and negative predictive values were 11% and 99%, respectively. If only these criteria had been used to obtain radiographs, 38% of films would have been omitted (at an estimated savings of $20,000) with only two suggestive radiographs missed.

Conclusion:

Our results suggest that restricting abdominal radiographs to patients with at least one of these five high-yield clinical features will detect most diagnostic and suggestive radiographs in children with major abdominal diseases.

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View all citing articles on Scopus

: Presented at the American College of Emergency Physicians Scientific Assembly in Boston, Massachusetts, October 1991.

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Original contributionPlain abdominal radiography in the detection of major disease in children: A prospective analysis

Study objective:

Design:

Setting:

Participants:

Methods and measurements:

Main results:

Conclusion:

Emerg Med Clin North Am

Emerg Med Clin North Am

Semin Roentgenol

Surg Clin North Am

Am J Surg

Ann Emerg Med

Ann Emerg Med

Clin Radiol

Semin Roentgenol

Semin Roentgenol

Am J Surg

Gastroenterology

Abdominal pain in children: Clues to identifying nontraumatic causes

Emerg Med Rep

The acute abdomen in childhood

Curr Prob Diag Radiol

Abdominal pain

Plain abdominal radiography in the detection of acute medical and surgical disease in children: A retrospective analysis

Pediatr Emerg Care

The utility of abdominal radiography in a pediatric emergency department

Ann Emerg Med

Children with abdominal pain: Evaluation in the pediatric emergency department

Pediatr Emerg Care

Original contribution
Plain abdominal radiography in the detection of major disease in children: A prospective analysis