American Academy of Pediatrics

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Released February 21, 2013; updated June 20, 2018

Computed tomography (CT) scans are not always necessary in the routine evaluation of abdominal pain.

CT imaging in the emergency department evaluation of children with abdominal pain is frequent and can be inconsistently used, including overused. While radiation is necessary to perform a CT scan, there is both misunderstanding and often concern about the radiation necessary and the debate over the potential long-term development of cancer from this radiation. There also is the potential for an unnecessary amount of radiation from inappropriately performed CT examinations, as there are unique approaches and considerations with CT examinations in children that allow for lower radiation doses. CT can be very valuable in the setting of pediatric abdominal pain, but only when it is the correct test to do at the time (as opposed to waiting, or using another test that does not depend on ionizing radiation especially ultrasound), and performed in the right way (child-sized CT techniques).


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics (AAP) employed a three-stage process to develop its list. Using the Academy’s varied online, print and social media communication vehicles, the first stage invited leadership of the Academy’s 88 national clinical and health policy-driven committees, councils and sections to submit potential topics via an online survey. The second stage involved expert review and evaluation of the management groups that oversee the functions of the committees, councils and sections. Based on a set of criteria (evidence to document unproven clinical benefit, potential to cause harm, over-prescribed and utilized, and within the purview of pediatrics) a list of more than 100 topics was narrowed down to five. Finally, the list was reviewed and approved by the Academy’s Board of Directors and Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

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Kim ME,, Orth RC, Fallon SC. et al. Performance of CT examinations in children with suspected acute appendicitis in the community setting – a need for more education. AJR 2105; 204:857-860.

Kim K, Kim YH, Kim SY, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med [Internet]. 2012 Apr 26;366:1596–1605.

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Niles LM, Goyal MK, Badolato GM, Chamberlain JM, Cohen JS. US emergency department trends in imaging for pediatric nontraumatic abdominal pain. Pediatrics. 2017; 140: Epub 2017 Sep 15.

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Strauss KJ, Goske MJ, Kaste SC, et al. Image Gently: Ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR 194:868-873, 2010.