Plain film X-rays may not be necessary in some children with non-traumatic stomach pain

May 05, 2004

The majority of plain films (X-rays), which are traditionally used to evaluate non-traumatic abdominal pain in children brought into the emergency department, may not be clinically useful, a panel of experts has found. Ultrasound and CT, on the other hand, are more clinically useful in evaluating these patients, a new study shows.

The study was carried out by a panel of two radiologists, a pediatric surgeon and a pediatric emergency department physician. The panel reviewed the history, physical examination and laboratory results, and imaging studies of 872 children seen over the course of 13 months at the Massachusetts General Hospital's emergency department. Of those 872 patients, 173 had plain film examinations. The panel determined that 72% of plain films were not clinically useful. In other words, they did not provide information that altered or ended the evaluation of the patient's abdominal pain, said David A. Boyajian. Dr. Boyajian, a medical student at Massachusetts General Hospital in Boston, MA, will present the study on May 4 at the American Roentgen Ray Society Annual Meeting in Miami Beach, FL. Plain films were most useful in confirming diagnoses of constipation and bowel obstruction, which most of the time were suspected by the clinicians prior to ordering the image, Dr. Boyajian said.

CT was performed in addition to the plain films on 34 children, said Dr. Boyajian; 35% had a useful plain film interpretation, while the panel found that CT interpretations were clinically useful in 91% of the cases, he said. Twenty-one children had both an ultrasound and plain film examination. Plain films were considered clinically useful in 24% of the cases compared to ultrasound, which was deemed useful in 43% of cases, said Dr. Boyajian.

"We aren't saying that plain films should be abandoned. These imaging studies worked well for confirming diagnoses of constipation and bowel obstruction. However, our results suggest that if diagnoses other than constipation and bowel obstruction are suspected, or if CT or ultrasound is already anticipated, then the plain film may be unnecessary," Dr. Boyajian said. "Foregoing the abdominal plain film in these patients would decrease unnecessary radiation exposure, delay to diagnosis and cost," he said.
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American College of Radiology

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