So Just What is the Best Way to Image a Child with Non-Traumatic Abdominal Pain? :

Choosing the most appropriate way to imaging a child with acute non-traumatic abdominal pain in the emergency department (ED) is easier said than done. This week, we share another study in this category but one that looks at imaging trends at a national level in EDs around the country.  Niles et al. (10.1542/peds.2017-0615) have analyzed data from the National Hospital Ambulatory Medical Care Survey to look at trends in computed tomography (CT) and ultrasound (US) use for belly pain from 2007 t0 2014.  The authors include more than 21 million pediatric ED visits in this study, and find 14.6% of children in this study received CT imaging, 10.9% US imaging, and 1.9% of children got both.  Interestingly the overall usage of both CT and US did not change over the study period, although there was less usage of CT and more usage of US in pediatric EDs versus general EDs.  This study does not provide information on the usefulness of this imaging in regard to diagnosis and treatment, nor does it weave in the use of MRI as a third mode of imaging.  Yet at a time when we are aware of the radiation risks of CT scans and the need to “image gently.” this study might be worth sharing with your colleagues in both your local ED and radiologist with the hope that pediatric protocols are in place no matter where the ED is located to reduce radiation exposure as much as possible to children if it is needed.  As to what imaging modality is best for children with non-traumatic abdominal pain, the best news from this study is that the majority did not need imaging for probable non-surgical causes which make up the brunt of this problem.  Hopefully after reading this study, you’ll make the right incision --oops we mean decision—and image only if the clinical evidence warrants it, using the modality that studies appearing in peer-reviewed journals like ours suggest are most helpful for the diagnosis suspected.