Plain abdominal radiography in the detection of major disease in children: a prospective analysis.
OBJECTIVE
To prospectively evaluate previously described high-yield clinical criteria for obtaining plain abdominal radiographs in the emergency evaluation of children.


METHODS
Prospective, observational study.


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


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


METHODS
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.


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.


CONCLUSIONS
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.
Rothrock
S G
SG
Department of Emergency Medicine, Orlando Regional Medical Center, Florida.
Green
S M
SM
Hummel
C B
CB
D000005:Abdomen / Q000601:surgery; D000006:Abdomen, Acute / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000000981:diagnostic imaging; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D011446:Prospective Studies; D011860:Radiography, Abdominal; D012680:Sensitivity and Specificity