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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.

Author information

1
Division of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA. Electronic address: alters@health.fau.edu.
2
Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA.
3
Department of Emergency Medicine, California Hospital Medical Center, Los Angeles, CA, USA.
4
Division of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.

Abstract

OBJECTIVE:

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.

METHODS:

Design: Retrospective cohort.

SETTING:

Community ED with volume of 85,000 annual visits.

POPULATION:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Abdominal imaging; Pediatric abdominal pain; Radiology reports

PMID:
28982533
DOI:
10.1016/j.ajem.2017.09.016
[Indexed for MEDLINE]

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