Computed Tomography of the Abdomen in Children Presenting to the Emergency Department with Abdominal Pain: Indications and Impact on Management

Background: Abdominal pain represents a common complaint of children presenting to the emergency department (ED). The underlying etiology ranges from benign disorders to conditions that require life-saving surgeries. Providers are faced with significant challenges in the evaluation of these patients. Since clinical assessment alone is not always sufficient to reach a correct diagnosis; the use of imaging has become an essential tool in evaluating children presenting with abdominal pain. In particular, computed tomography (CT) emerged as one of the most commonly used imaging for this purpose.

Objective: The objective of this study was to detect the incidence of use of CT of the abdomen and its impact on children presenting to the ED of the American University of Beirut Medical Center (AUBMC) with abdominal pain.

Methods: This was a retrospective chart review of children between 3 and 15 years of age presenting with abdominal pain to the ED department at AUBMC from January 1, 2014 to December 31, 2014. Patients’ demographics, pain severity, duration, associated symptoms, CT abdomen results and management were collected.

Results: A total of 464 pediatric ED visits to AUBMC were made with the chief complaint of abdominal pain (253 males and 211 females). Up to 10% of these patients (N=46) underwent an abdominal CT upon their presentation. These patients had mainly severe right lower quadrant pain commonly associated with nausea and vomiting. Appendicitis was the most common pathologic finding seen on imaging (30.4%, N=14) followed by mesenteric adenitis (21.7%, N=10).

Conclusion: The most common etiology of abdominal pain in children that require imaging with abdominal CT is appendicitis. Our data demonstrate that more than half of children who underwent CT did not have any modification in management; this would lead us to call for a thoughtful approach taking into consideration radiation toxicity and cost.