Children with abdominal pain, vomiting or constipation should receive AXR to guide management
Date First Published:
January 22, 2024
Last Updated:
January 23, 2024
Report by:
Ching Yeung Li, Resident (Queen Mary Hospital )
Three-Part Question:
In [children with abdominal symptoms] is [AXR] useful in [identifying intra-abdominal pathology and guiding management]?
Clinical Scenario:
A 5 year old boy is brought into the Emergency Department by his mother. He complains ofconstipation. You consider ordering an AXR to rule out intra-abdominal pathology and guide management.
Search Strategy:
National Library of Medicine 1978-2024 using the OVID interface.
Search Details:
({constipation vomiting pain abdominal radiograph children} LIMIT to human AND english.
Outcome:
18 papers found of which 15 were irrelevant or of insufficient quality. The remaining 3 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Diagnostic Yield of Abdominal Radiographs in the Pediatric Emergency Department Kubiszewski K, Patterson S, Chalise S, Rivera-Sepulveda A. Diagnostic Yield of Abdominal Radiographs 2023 USA | Retrospective, cross-sectional study of patients aged 0 to 18 years with an AR who visited the PED between 2017 and 2019. Diagnostic yield was analyzed with sensitivity, specificity, positive predictive value, negative predictive value (NPV), and likelihood ratio. | Retrospective survey. | Abnormal AXR Rate | The incidences of an abnormal AR in abdominal pain, vomiting, and constipation were 26%, 37%, and 50%, respectively. There was a 13% rate of clinically significant diagnoses. The AR diagnostic yield showed 44% sensitivity, 70% specificity, 17% positive predictive value, and 90% NPV (P < 0.05). | |
| Abdominal radiography is not necessary in children with intussusception Tareen F, Mc Laughlin D, Cianci F, Hoare SM, Sweeney B, Mortell A, Puri P. Abdominal radiography is 2015 USA | Index cases of intussusception presenting over 15 years (1998-2013) were analysed. | Retrospective survery | Outcome of pneumatic reduction of intussusception (PRI) between AXR and no AXR groups was compared. | The success rate of pneumatic reduction of intussusception did not differ between AR positive (82 %) and AR normal (84 %). Occult pneumoperitoneum was not detected in any patient by AR in our cohort. | Only specific to 1 condition (Intusseception) |
| Plain abdominal radiography in the detection of major disease in children: a prospective analysis Rothrock SG, Green SM, Hummel CB 1992 USA | 354 children 15 years old or younger who underwent plain abdominal radiography during a one-year period | Prospective, observational study | The presence of any of the following features--prior abdominal surgery, foreign body ingestion, abnormal bowel sounds, abdominal distention, or peritoneal signs--was 93% sensitive and 40% specific in detecting diagnostic or suggestive radiographs in patients with major disease. Positive and negative predictive values were 11% and 99%, respectively. If only these criteria had been used to obtain radiographs, 38% of films would have been omitted (at an estimated savings of $20,000) with only 2 suggestive radiographs missed. | Restricting abdominal radiographs to patients with at least one of these five high-yield clinical features will detect most diagnostic and suggestive radiographs in children with major abdominal diseases. |
Author Commentary:
All studies stress the importance of history and physical examination in diagnosing abdominal pathology in children with questionable yield of AXR.
Bottom Line:
AXR interpretation rarely alters the management of a child with abdominal complaints and should be ordered with careful consideration of clinical need evaluated from history and physical examination in view of high radiation dose.
References:
- Kubiszewski K, Patterson S, Chalise S, Rivera-Sepulveda A. Diagnostic Yield of Abdominal Radiographs. Diagnostic Yield of Abdominal Radiographs in the Pediatric Emergency Department
- Tareen F, Mc Laughlin D, Cianci F, Hoare SM, Sweeney B, Mortell A, Puri P. Abdominal radiography is . Abdominal radiography is not necessary in children with intussusception
- Rothrock SG, Green SM, Hummel CB. Plain abdominal radiography in the detection of major disease in children: a prospective analysis