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Am J Emerg Med. 2018 Apr;36(4):556-559. doi: 10.1016/j.ajem.2017.09.016. Epub 2017 Sep 14.

Radiology report "disclaimers" increase the use of abdominal CT in the work-up of pediatric abdominal pain.

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Division of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA. Electronic address:
Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA.
Department of Emergency Medicine, California Hospital Medical Center, Los Angeles, CA, USA.
Division of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.



Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a "disclaimer" is associated with additional imaging.


Design: Retrospective cohort.


Community ED with volume of 85,000 annual visits.


Consecutive ED patients <21-years-old with appendix U/S over 12-months. Radiologist reports were assessed for disclaimers and if definitive diagnoses of appendicitis were made. The incidence of subsequent CT imaging was determined and group differences between categories were calculated.


441 eligible patients were identified with average age 11.7years. Of all U/S studies, 26% were definitive for appendicitis and 74% were non-definitive. Disclaimers were included on 60% of all studies, including 13% of definitive studies and 76% of non-definitive studies. 25% of all studies including a disclaimer had follow-up CT versus 10% of studies without a disclaimer (15% difference; 95% CI: 9-21). For patients with definitive interpretations, 6% had follow-up CT with no significant difference between groups with or without a disclaimer. For patients with non-definitive studies, 26% with a disclaimer had follow-up CT scans versus 13% without a disclaimer (13% difference; 95% CI: 4-22).


Appendix ultrasound interpretations often include a disclaimer, which leads to a 150% increase in follow-up CT imaging. We suggest that radiologists consider the impact of including such a disclaimer, knowing that this may contribute to possible unnecessary imaging.


Abdominal imaging; Pediatric abdominal pain; Radiology reports

[Indexed for MEDLINE]

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