Article of the Week: The Rise in CT Scanning of Abdominal Pain in Kids

by Moh Saidinejad

This week’s article comes from the November 2012 issue of Pediatrics. It is from the San Francisco Bay area, and consists of a 11-year longitudinal observational study of CT use in children presenting to the ED with abdominal pain. (1998-2008) 

It made me think about how much we rely on imaging for abdominal pain, especially to rule out surgical abdomen. Of course we typically try ultrasonography before we go to CT.  This study looks at the trend of CT use over an 11-year span between 1998 and 2008.  Interestingly, the data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) shows that CT use has sharply risen during this time, but this increase varies by patient age, ethnicity, and gender. Interestingly, while the overall CT use has increased, the use of ultrasound and plain radiographs has not changed. 

In addition to this, prevalence of the diagnosis of appendicitis and hospitalization rates have also not changed. This is interesting, because in the face of associated malignancy risk with the dose of radiation required for abdominal CT, this rise in CT use does not seem to be justifiable, if this is not associated with more positive appendicitis diagnosis or hospitalization. It is also interesting that older age, male gender, and white race are associated with higher prevalence of CT use. This study provides an opportunity to address a gap in diagnostic technology that can be aimed at outcome based decision rules for identification of low probability cases, where CT use can be avoided.