Choosing Wisely:

CT scans are not necessary in the routine evaluation of abdominal pain.

Rationale and Comments: Utilization of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk of cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs. There also is the potential for radiation overdose with inappropriate CT protocols.
Sponsoring Organizations:
  • American Academy of Pediatrics
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gastroenterologic
  • Pediatric
  • Emergency medicine
  • References: • Brenner DJ, et al. Computed tomography–an increased risk of radiation exposure. N Engl J Med. 2007;357:2277-84.
    • Burr A, et al. Glowing in the dark: time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children. J Pediatr Surgery. 2011;46(1): 188-91.
    • Kyuseok Kim, et al. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. 2012;366:1596-605.
    • Stewart K, et al. Sonography for appendicitis: nonvisualiza-tion of the appendix is an indication for active clinical observation rather than direct referral for computed tomography. J Clin Ultrasound. 2012;40(8):455-61.
    • Pearce MS, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012; 380(9840):499-505.
    • Saito JM. Beyond appendicitis: evaluation and surgical treatment of pediatric acute abdominal pain. Curr Opin Pediatr. 2012;24(3):357-64.

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