Plain abdominal radiography in the detection of major disease in children: a prospective analysis

Ann Emerg Med. 1992 Dec;21(12):1423-9. doi: 10.1016/s0196-0644(05)80053-8.


Study objective: To prospectively evaluate previously described high-yield clinical criteria for obtaining plain abdominal radiographs in the emergency evaluation of children.

Design: Prospective, observational study.

Setting: Emergency departments of a university medical center and an affiliated county hospital.

Participants: Three hundred fifty-four children 15 years old or younger who underwent plain abdominal radiography during a one-year period.

Methods and measurements: Physicians ordering plain abdominal radiographs completed data forms that included historical and physical examination information before viewing films. At a later date, records of all patients were reviewed for radiologist interpretation and final diagnosis. The data were analyzed to determine the sensitivity, specificity, and predictive values of previously described high-yield criteria (from a retrospective series) in detecting radiographs that were diagnostic or suggestive of "major" abdominal disease.

Main results: Sixty-one patients (17%) had major diseases potentially requiring procedural intervention (eg, appendicitis, ingested foreign bodies, and intussusception), whereas 296 patients (83%) had minor diseases not requiring procedural intervention (eg, gastroenteritis and nonabdominal diagnoses). The presence of any of the following features--prior abdominal surgery, foreign body ingestion, abnormal bowel sounds, abdominal distention, or peritoneal signs--was 93% sensitive and 40% specific in detecting diagnostic or suggestive radiographs in patients with major disease. Positive and negative predictive values were 11% and 99%, respectively. If only these criteria had been used to obtain radiographs, 38% of films would have been omitted (at an estimated savings of $20,000) with only two suggestive radiographs missed.

Conclusion: Our results suggest that restricting abdominal radiographs to patients with at least one of these five high-yield clinical features will detect most diagnostic and suggestive radiographs in children with major abdominal diseases.

Publication types

  • Review

MeSH terms

  • Abdomen / surgery
  • Abdomen, Acute / diagnostic imaging
  • Abdominal Pain / diagnostic imaging
  • Adolescent
  • Child
  • Child, Preschool
  • Gastrointestinal Diseases / diagnostic imaging*
  • Humans
  • Prospective Studies
  • Radiography, Abdominal*
  • Sensitivity and Specificity