Background Pediatric abdominal pain visits to emergency departments (ED) are common. The objectives of this study are to assess variation in imaging [ultrasound (US) ± computed tomography (CT)] and factors associated with isolated CT use. Methods This was a retrospective cohort study of ED visits for pediatric abdominal pain resulting in discharge from 16 regional EDs from 2007–2013. Primary outcome was US or CT imaging. Secondary outcome was isolated CT use. We used multivariable logistic regression to evaluate patient- and hospital-level covariates associated with imaging. Results Of the 21,152 visits, imaging was performed in 29.7%, and isolated CT in 13.4% of visits. In multivariable analysis, black patients (OR: 0.4 (95%CI: 0.4, 0.5)) and Medicaid (OR: 0.6 (95%CI: 0.5, 0.7)) had lower odds of advanced imaging compared to white patients and private insurance, respectively. General EDs were less likely to perform imaging (OR: 0.6 (95%CI: 0.5, 0.7)) compared to the pediatric ED; however, for visits with imaging, 3.5% of visits to the pediatric ED compared to 76% of those to general EDs included an isolated CT (P<0.001). Low pediatric volume (OR: 1.8 (95%CI:1.5, 2.2)) and rural (OR:1.8 (95%CI:1.3, 2.5)) EDs had higher odds of isolated CT use, compared to higher pediatric volumes and non-rural EDs, respectively. Conclusion There are racial and insurance disparities in imaging for pediatric abdominal pain. General EDs are less likely than pediatric EDs to use imaging, but more likely to use isolated CT. Strategies are needed to minimize disparities and improve the use of “ultrasound-first.”

A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.

Abdominal pain and constipation are common chief complaints in the pediatric emergency department. We present a case of a child with pain, abdominal distention, and constipation ultimately diagnosed with an ovarian teratoma and the role of point-of-care ultrasonography in the evaluation.

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