Khan Hamza H, Subedi Shova, Kumar Sanjay, Lyons Hernando
Medicine, Shifa International Hospital, Islamabad, PAK.
Pediatrics, Ascension St. John Hospital, Detroit, USA.
Cureus. 2021 Oct 31;13(10):e19162. doi: 10.7759/cureus.19162. eCollection 2021 Oct.
Background and objective Pediatric populations are highly sensitive to ionizing radiations and, therefore, are more at risk of their harmful outcomes. Our study aimed to determine the percentage of children who underwent a CT scan after presenting to the ED with abdominal pain. The secondary aim was to determine the change in management related to the CT results. In addition, we also wanted to determine the predictors associated with the use of abdominal CT scans in the evaluation of children presenting to ED with abdominal pain as well as the predictors associated with positive CT scan results in children with abdominal pain. Materials and methods We retrospectively reviewed the medical records of children with abdominal pain seen in our ED from 01/01/2011 through 12/30/2012. Patients aged 4-18 years presenting with abdominal pain were identified from the medical records. Data on demographics, clinical characteristics, associated factors, CT use, CT findings, and change in management were collected. Data were analyzed using Chi-square (χ) analysis and Student's t-test. Results A total of 1,780 charts were reviewed and 1,272 children were included in the study. The mean age of the cohort was 12.6 ± 4.6 years; 62.6% were female and 68.7% were African American. Of note, 14% (181/1,272) of the study group had received a CT scan; change in medical management was noted in 34.8% (63/181) of the scanned patients. Predictors of CT use included older age (p<0.0001), male gender (p<0.0001), white race (p<0.0001), an attending without advanced training in pediatric emergencies (p=0.001), acute onset of symptoms (p<0.0001), higher pain score (p<0.0001), right lower quadrant pain (p<0.0001), abdominal wall rebound tenderness (p<0.0001), abdominal tenderness (p<0.0001), fever (p<0.0001), and absence of constipation (p=0.04). Positive CT scan results were predicted by the presence of fever (p=0.013), lack of constipation (p=0.025), and white race (p=0.022). A multivariate analysis could not be done because not all data were available for each patient. Conclusion The use of the CT scan in children with abdominal pain affected the management in one out of three patients (34.8%). Fever, constipation, and white race were the factors associated with an increased likelihood of performing a CT scan and were also linked to positive results.
背景与目的 儿科人群对电离辐射高度敏感，因此，他们遭受有害后果的风险更高。我们的研究旨在确定因腹痛就诊于急诊科后接受CT扫描的儿童比例。次要目的是确定与CT结果相关的管理变化。此外，我们还想确定在评估因腹痛就诊于急诊科的儿童时与使用腹部CT扫描相关的预测因素，以及与腹痛儿童CT扫描阳性结果相关的预测因素。
材料与方法 我们回顾性分析了2011年1月1日至2012年12月30日期间在我们急诊科就诊的腹痛儿童的病历。从病历中确定年龄在4至18岁且有腹痛症状的患者。收集了关于人口统计学、临床特征、相关因素、CT使用情况、CT检查结果及管理变化的数据。使用卡方（χ）分析和学生t检验对数据进行分析。
结果 共审查了1780份病历，1272名儿童纳入研究。该队列的平均年龄为12.6±4.6岁；62.6%为女性，68.7%为非裔美国人。值得注意的是，研究组中有14%（181/1272）的儿童接受了CT扫描；在接受扫描的患者中，34.8%（63/181）的患者医疗管理有变化。CT使用的预测因素包括年龄较大（p<0.0
