Abstract
The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities.
Highlights
Acute abdominal pain is a common cause of pediatric visits to the emergency department (ED)
There were 156 ED computed tomography studies performed for acute abdominal pain in the pediatric emergency department during the 3-year period of this study
Forty-six patients who underwent multidetector computed tomography (MDCT) revealed findings negative for appendicitis; one of them had persistent abdominal pain, and was later diagnosed with appendicitis that was proven by postoperative pathology
Summary
Acute abdominal pain is a common cause of pediatric visits to the emergency department (ED). A physical examination, and sonography can help physicians diagnose appendicitis out of various possible causes [3,4,5], physicians in the ED often order computed tomography (CT) when pediatric acute abdominal pain suggests appendicitis because CT has been proven to improve patient outcomes as reflected by lower negative laparotomy and perforation rates [6, 7]. A dramatic increase in the use of CT in pediatric patients with abdominal pain has been observed in recent years without any change in the use of other imaging techniques, hospital admission rates, incidences of appendicitis, or severity of disease [8, 9].
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