438 - Do imaging patterns for abdominal pain differ between tertiary and non-tertiary Paediatric Emergency Departments?

Publication Number: 438.4335

Mumtaz Mooncey, Monash Children's Hospital, Melbourne, Australia, Melbourne, Victoria, Australia; Simon Craig, Monash University, Clayton, Victoria, Australia; Phyllis Lin, Monash University, Box Hill, Victoria, Australia

Background: Abdominal pain is a common presentation to the Paediatric Emergency Department (ED). Although most presentations are not due to a serious condition, imaging may be necessary to exclude significant pathology. In Australia, most children are not seen at tertiary paediatric EDs; they are seen at non-tertiary departments which serve a mixed population (adults and children). It is unknown whether imaging patterns are consistent between tertiary paediatric EDs and non-tertiary EDs.

Objective: (1) To determine patterns of imaging requested for children with abdominal pain presenting to ED in the Australian setting.
(2) To compare these patterns between a tertiary paediatric ED and two non-tertiary “mixed” EDs.

Design/Methods: Retrospective review of Electronic Health Record (EHR) data of children aged 0-16 years presenting to three Australian EDs between 2020 and 2022 (three years). Cases were included if an ED Presenting Complaint of “abdominal pain” was recorded.
All imaging orders were extracted from the EHR, including requests for plain abdominal radiographs, ultrasound, CT abdomen and MRI. We determined rates of each imaging modality, and made comparisons between the tertiary and non-tertiary EDs.

Results: In this study, 15,661 relevant presentations were identified; with 10,085 presenting to tertiary ED and 5,576 presenting to non-tertiary hospitals. Overall, abdominal imaging was requested in 3,777 cases (24.1%; 95% CI 23.5 – 24.8); with 2,620 cases in the tertiary setting (26.0%, 95% CI 25.1 – 26.9), and 1157 in the non-tertiary setting (20.7%, 95% CI 19.7 – 21.8).

Ultrasound scans were most commonly requested, followed by abdominal radiographs. Ultrasounds were requested in 2,382 patients in tertiary, (23.6%, 95% CI 22.8 – 24.5), and in 1,012 patients in non-tertiary (18.1%, 95% CI 17.1 – 19.2). Plain films in the tertiary hospital were requested in 456 patients (4.5%, 95% CI 4.1 – 5.0), and in 200 patients (3.6%, 95% CI 3.1 – 4.1) in the non-tertiary hospitals. No CT or MRI scans were requested in either setting.

Conclusion(s): There is no significant difference in imaging patterns for abdominal pain between tertiary and non-tertiary paediatric Emergency Department settings.

Abdominal Pain - Patient Presentations to the ED
Patient Demographics, Triage and Presenting Complaint details

Imaging and Investigations
Imaging and Investigation requests