Clinical recommendation	Evidence rating	Comments
Analgesia should be provided for patients with acute abdominal pain because it improves patient comfort, does not hinder accuracy of the physical examination, and may facilitate the assessment.24,25	A	Two systematic reviews of randomized controlled trials assessing diagnostic accuracy and other patient-oriented outcomes
Right upper quadrant ultrasonography should be performed in patients with suspected acute cholecystitis because no single clinical finding can exclude this diagnosis.13,37,38	C	Disease-oriented evidence based on systematic review of cohort studies and two guidelines
Clinical diagnosis of left-sided diverticulitis is reasonable for patients who are immunocompetent without risk factors for complicated diverticulitis, reserving CT imaging for cases of diagnostic uncertainty.47	C	Conditional recommendation from the American College of Physicians based on one systematic review that found limited evidence that imaging improved outcomes over clinical diagnosis alone
Abdominopelvic CT with intravenous contrast media is the imaging test of choice in nonpregnant patients with right lower quadrant pain, but ultrasonography and clinical risk scores can assist with selective use of CT.9,33,44,48,57–60,68	C	Narrative reviews, systematic reviews, observational studies, and American College of Radiology Appropriateness Criteria on the role of imaging
Ultrasonography and MRI are the imaging tests of choice in pregnant patients presenting with suspected appendicitis.Abdominal CT can be considered if ultrasonography is nondiagnostic and MRI is unavailable.65,66,68	C	Disease-oriented evidence based on two systematic reviews and meta-analysis; American College of Radiology Appropriateness Criteria