# Lesson from a Single Pediatric Emergency Department: Potentially Applicable Radiation-Minimizing Practices for Non-Traumatic Abdominal Pain in Adolescents

## TL;DR

Pediatric emergency departments use less radiation and more ultrasound for adolescent abdominal pain without compromising safety.

## Contribution

Demonstrates that pediatric ED imaging practices reduce radiation exposure in adolescents without sacrificing safety.

## Key findings

- Pediatric ED physicians used fewer CT scans and CT phases compared to adult ED physicians.
- Point-of-care ultrasound was used significantly more in the pediatric ED.
- Safety outcomes were comparable between the two EDs despite reduced radiation exposure.

## Abstract

What are the main findings?

Pediatric emergency department (PED) physicians used significantly fewer CT scans (28.5% vs. 37.9%) and fewer CT phases per patient (0.49 vs. 0.76 per patient) compared to adult ED physicians, while utilizing point-of-care ultrasound (POCUS) significantly more frequently (28.0% vs. 0.1%).

Despite reduced radiation exposure and simplified imaging strategies (fewer CT phases and single-view X-rays), safety outcomes remained comparable between PED and AED.

What is the implication of the main finding?

These findings support radiation-minimizing imaging practices in adolescents by highlighting the feasibility of POCUS as a frontline tool in the pediatric ED.

Adoption of similar PED-style imaging strategies could reduce unnecessary radiation exposure in adolescents without compromising clinical outcomes.

Background/Objectives: In emergency departments (EDs), choosing imaging modalities for adolescents with abdominal pain requires balancing diagnostic accuracy and minimizing radiation exposure. This retrospective study compared imaging modalities in adolescents (16–18 years) presenting with non-traumatic acute abdominal pain between the pediatric ED (PED) and adult ED (AED) in the same institution. Methods: We conducted a retrospective study in patients aged 16–18 years who presented to AED or PED in the same tertiary university-affiliated hospital due to non-traumatic acute abdominal pain between January 2019 and July 2023 (study period = 55 months). The patient freely decided on the emergency department (ED) to be admitted. Results: This study analyzed 950 patients (683 in AED and 267 in PED). Actionable and surgical emergencies were comparable between both EDs (p = 0.617 and 0.245, respectively). PED physicians used fewer CT scans (28.5% vs. 37.9%, p = 0.006) and fewer CT phases (mean, 0.49 vs. 0.76, p < 0.001). Despite more patients undergoing X-rays in PED (77.9% vs. 61.6%, p < 0.001), the number of X-ray images was lower than in AED (mean, 0.9 vs. 1.1, p < 0.001). PED performed more point-of-care US (POCUS) than AED (28.0% vs. 0.1%, p < 0.001). Both EDs had comparable safety outcomes (revisits and missed surgical emergencies). Conclusions: PED physicians utilize POCUS more frequently and employ fewer CT scans, X-ray images, and CT phases than AED physicians in adolescents presenting with non-traumatic acute abdominal pain. Despite lower radiation exposure, the PED achieved safety outcomes comparable to the AED’s, indicating that a PED-style imaging strategy may be safely applied to adolescent abdominal pain evaluation.