Campaigns Against Ionizing Radiation and Changed Practice Patterns for Imaging Use in Pediatric Appendicitis

Richards, Morgan K.; Kotagal, Meera; Goldin, Adam B.

doi:10.1001/jamapediatrics.2015.0912

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…(11,12,13) As a result, both national and international campaigns aimed at reducing the use of potentially harmful imaging modalities are becoming increasingly well-known and effective. (14,15,16,17,18) While estimates vary, approximately 5 to 10% of children have plain abdominal radiographs obtained as part of their diagnostic evaluation for pediatric abdominal pain. (19) Retrospective review of plain radiograph use for acute pediatric abdominal pain suggests that less than one-quarter of these patients are eventually diagnosed with a condition that would potentially require acute intervention.…”

Section: Introductionmentioning

confidence: 99%

Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation

Kearney¹,

Edwards

Bradford³

et al. 2018

Pediatr Emer Care

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Background: Abdominal pain is the fourth most common pediatric outpatient complaint, with over half eventually being diagnosed with constipation. X-ray use in the evaluation of constipation is variable: 4% in outpatient/clinic settings but over 70% of children with constipation evaluated in an emergency department. X-rays use increases misdiagnosis rate, remains costly, and involves radiation exposure. Objectives: To assess the use of plain radiographs by Pediatric Emergency Medicine (PEM) providers in the routine diagnostic evaluation and management of pediatric constipation Methods: A cross-sectional, quarterly survey of pediatric emergency medicine providers was performed. Survey participants were subscribers to the American Academy of Pediatrics Section On Emergency Medicine (AAP-SOEM) list-serv. Participants were presented a case of pediatric constipation meeting Rome-III clinical criteria to assess both diagnostic and therapeutic approaches. Participants were asked to categorize frequency of x-ray use, reasons for obtaining, estimated diagnostic utility, and elements of institutional standard diagnostic approach to constipation, if applicable. Descriptive statistical analyses were performed. Results: 305 of 1272 eligible list-serv members (24%) responded, with 272 complete surveys. 86% were PEM-boarded with over half more that 10 years since completing fellowship. 99% elected to treat for constipation a child meeting Rome-III clinical criteria; one-third (31%) would obtain plain radiographs for this same child. Plain radiographs were viewed as somewhat (59%) or minimally (29%) valueadded in the clinical evaluation of suspected pediatric constipation. The most common reasons for obtain plain radiographs were: obtaining family buy-in (44%) and ruling out other diagnosis (19%). Frequency of x-ray use varied across geographic regions and with participant and hospital characteristics. Conclusion: This survey suggests that many physicians are obtaining radiographs to convince families of the diagnosis of constipation. This is not a viable management plan given the risks of radiation as well as financial costs to the family and medical system. There remains room for improvement as we attempt to reduce use of ionizing radiation in the evaluation of common pediatric illnesses.

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Section: Introductionmentioning

confidence: 99%

Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation

Kearney¹,

Edwards

Bradford³

et al. 2018

Pediatr Emer Care

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“…5 These trends may be problematic and although not associated with direct exposure to ionizing radiation, the mixed test performance of ultrasound, could potentially lead to unnecessary testing and increased health care expenditures. 6 For this reason, a more nuanced approach in which risk for appendicitis is more accurately determined may offer clinical benefit.…”

Section: Introductionmentioning

confidence: 99%

A Clinical Score to Predict Appendicitis in Older Male Children

Kharbanda

Monuteaux

Bachur

et al. 2017

Academic Pediatrics

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Objective To develop a clinical score to predict appendicitis among older, male children who present to the emergency department (ED) with suspected appendicitis. Methods Patients with suspected appendicitis were prospectively recruited at 9 pediatric EDs. A total 2,625 patients enrolled; a subset of 961 males, age 8-18 were analyzed in this secondary analysis. Outcomes determined by pathology, operative reports and follow-up calls. Clinical and laboratory predictors with < 10% missing data and Kappa > 0.4 were entered into a multivariable model. Resultant beta-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and likelihood ratios [LRs]. Results The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in RLQ, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥ 8.1 had a sensitivity of 25% [95% CI 20-29%], specificity of 98% [96-99%] and PPV of 93% [86-97%] for ruling in appendicitis. Conclusion We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score may allow clinicians to manage a proportion of these male patients without diagnostic imaging.

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“…Asimismo, es de señalar que para evitar ese riesgo, surgieron en muchos países varias campañas para eliminar la radiación ionizante en los estudios de imágenes en pediatría. 3 El sobrediagnóstico en la atención pediátrica es de menor frecuencia, siendo alrededor de 10 % del realizado en adultos, Sin embargo, el daño en niños puede ser más perjudicial en varios trastornos que son producidos por el médico, y no por una enfermedad. Un ejemplo, es cuando el pediatra indica en forma innecesaria…”

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El sobrediagnóstico en la práctica de la pediatría

2020

Arch Argent Pediat

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Campaigns Against Ionizing Radiation and Changed Practice Patterns for Imaging Use in Pediatric Appendicitis

Cited by 7 publications

References 15 publications

Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation

Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation

A Clinical Score to Predict Appendicitis in Older Male Children

El sobrediagnóstico en la práctica de la pediatría

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