title: Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department.
abstract: Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18 years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. "Positive" AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29 % (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n = 485; 90 %). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.
authors.affiliation: Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Lulu
authors.initials: L
authors.lastname: He
authors.affiliation: Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Park
authors.affiliation: Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Vachhani
authors.affiliation: Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Esben
authors.initials: E
authors.lastname: Vogelius
authors.affiliation: University of Texas Health Sciences Center Houston, 6431 Fannin Street, MSB 1.130B, Houston, TX, 77030, USA.
authors.forename: Chakradhar
authors.initials: C
authors.lastname: Thupili
authors.affiliation: University of Arizona Health Sciences Center, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA. unniu@radiology.arizona.edu.
authors.forename: Unni
authors.identifier: http://orcid.org/0000-0001-5605-9851
authors.initials: U
authors.lastname: Udayasankar
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Abdominal pain; Children; Emergency; Radiation; Radiographs