title: ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age.
abstract: Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant's age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota. Electronic address: molly.raske@childrensmn.org.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Raske
authors.affiliation: Texas Scottish Rite Hospital, Dallas, Texas.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Dempsey
authors.affiliation: C. S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: Children's Hospitals, San Diego, California.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Dory
authors.affiliation: Division of General and Hospital Pediatrics, Columbia, South Carolina; American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Garber
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Hayes
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada; American Association of Neurological Surgeons, Rolling Meadows, Illinois; Congress of Neurological Surgeons, Schaumburg, Illinois.
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.affiliation: American Association of Neurological Surgeons, Rolling Meadows, Illinois; Congress of Neurological Surgeons, Schaumburg, Illinois; Children's National Medical Center, Washington, District of Columbia.
authors.forename: John S
authors.initials: JS
authors.lastname: Myseros
authors.affiliation: Duke University Medical Center, Durham, North Carolina; American Pediatric Surgical Association, Deerfield, Illinois.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Rigsby
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Maura E
authors.initials: ME
authors.lastname: Ryan
authors.affiliation: C. S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Strouse
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sjirk J
authors.initials: SJ
authors.lastname: Westra
authors.affiliation: University of California, Davis, Sacramento, California.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Coley
authors.affiliation: Riley Hospital for Children, Indiana University, Indianapolis, Indiana.
authors.forename: Boaz
authors.initials: B
authors.lastname: Karmazyn
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019275:Radiopharmaceuticals; D014839:Vomiting / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals
keywords: Appropriateness Criteria; diagnostic imaging; infant; newborn; vomiting