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Pediatric Radiology

, 38:707 | Cite as

Radiologic procedures, policies and protocols for pediatric emergency medicine

  • George A. WoodwardEmail author
ALARA: BUILDING BRIDGES BETWEEN RADIOLOGY AND EMERGENCY MEDICINE
  • 129 Downloads

Abstract

Protocol development between radiology and pediatric emergency medicine requires a multidisciplinary approach to manage straightforward as well as complex and time-sensitive needs for emergency department patients. Imaging evaluation requires coordination of radiologic technologists, radiologists, transporters, nurses and coordinators, among others, and might require accelerated routines or occur at sub-optimal times. Standardized protocol development enables providers to design a best practice in all of these situations and should be predicated on evidence, mission, and service expectations. As in any new process, constructive feedback channels are imperative for evaluation and modification.

Keywords

Protocols Policies Pediatric emergency Radiologic 

Notes

Acknowledgements

Credit for development of the algorithms included in this paper goes to the physicians, nurses, technicians and other care providers at Children’s Hospital and Regional Medical Center. These algorithms are used with permission of Children’s Hospital and Regional Medical Center, Seattle, WA.

References

  1. 1.
    Impellizzeri P, Centonze A, Antonuccio P et al (2002) Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age. A retrospective study. Minerva Chir 57:341–346PubMedGoogle Scholar
  2. 2.
    Kaneko K, Tsuda M (2004) Ultrasound-based decision-making in the treatment of acute appendicitis in children. J Pediatr Surg 39:1316–1320PubMedCrossRefGoogle Scholar
  3. 3.
    Kosloske AM, Love CL, Rohrer JE et al (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34PubMedCrossRefGoogle Scholar
  4. 4.
    Kwok MY, Kim MK, Gorelick MH (2004) Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 20:690–698 quiz 699–701PubMedCrossRefGoogle Scholar
  5. 5.
    Malik AA, Wani N (1998) Continuing diagnostic challenge of acute appendicitis: evaluation through modified Alvarado score. Aust NZ J Surg 68:504–505CrossRefGoogle Scholar
  6. 6.
    Newman K, Ponsky T, Kittle K et al (2003) Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 38:372–379 discussion 372–379PubMedCrossRefGoogle Scholar
  7. 7.
    Garcia Pena BM, Taylor GA, Fishman SJ et al (2002) Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis. Pediatrics 110:1088–1093CrossRefGoogle Scholar
  8. 8.
    Smink DS, Finkelstein JA, Garcia Pena BM et al (2004) Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg 39:458–463 discussion 458–463PubMedCrossRefGoogle Scholar
  9. 9.
    Reid SR, Losek JD (2003) Imaging before appendectomy. Pediatrics 112:1461–1462 author reply 1461–1462PubMedCrossRefGoogle Scholar
  10. 10.
    Byrne AT, Geoghegan T, Govender P et al (2005) The imaging of intussusception [erratum appears in Clin Radiol 2005 Mar 60:412 Note: Goeghegan, T (corrected to Geoghegan, T)] Clin Radiol 60:39–46Google Scholar
  11. 11.
    Armstrong FD (2005) Analgesia for children with acute abdominal pain: a cautious move to improved pain management. Pediatrics 116:1018–1019PubMedCrossRefGoogle Scholar
  12. 12.
    Bailey B, Bergeron S, Gravel J et al (2007) Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial. Ann Emerg Med 50:371–378PubMedCrossRefGoogle Scholar
  13. 13.
    Green R, Bulloch B, Kabani A et al (2005) Early analgesia for children with acute abdominal pain. Pediatrics 116:978–983PubMedCrossRefGoogle Scholar
  14. 14.
    Kim MK, Strait RT, Sato TT et al (2002) A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 9:281–287PubMedCrossRefGoogle Scholar
  15. 15.
    Thomas SH, Silen W, Cheema F et al (2003) Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg 196:18–31PubMedCrossRefGoogle Scholar
  16. 16.
    Wolfe JM, Smithline HA, Phipen S et al (2004) Does morphine change the physical examination in patients with acute appendicitis. Am J Emerg Med 22:280–285PubMedCrossRefGoogle Scholar

Suggested reading

  1. 17.
    Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564PubMedCrossRefGoogle Scholar
  2. 18.
    Andersson RE, Hugander AP, Ghazi SH et al (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140PubMedCrossRefGoogle Scholar
  3. 19.
    Bond GR, Tully SB, Chan LS et al (1990) Use of the MANTRELS score in childhood appendicitis: a prospective study of 187 children with abdominal pain. Ann Emerg Medicine 19:1014–1018CrossRefGoogle Scholar
  4. 20.
    Cardall T, Glasser J, Guss DA (2004) Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis. Acad Emerg Med 11:1021–1027PubMedCrossRefGoogle Scholar
  5. 21.
    Cass DL (2005) Ovarian torsion. Semin Pediatr Surg 14:86–92PubMedCrossRefGoogle Scholar
  6. 22.
    Gronroos JM, Gronroos P (1999) Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 86:501–504PubMedCrossRefGoogle Scholar
  7. 23.
    Hagendorf BA, Clarke JR, Burd RS (2004) The optimal initial management of children with suspected appendicitis: a decision analysis. J Pediatr Surg 39:880–885PubMedCrossRefGoogle Scholar
  8. 24.
    Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16:34–40PubMedCrossRefGoogle Scholar
  9. 25.
    O’Shea JS, Bishop ME, Alario AJ et al (1988) Diagnosing appendicitis in children with acute abdominal pain. Pediatr Emerg Care 4:172–176PubMedGoogle Scholar
  10. 26.
    Paris CA, Klein EJ (2002) Abdominal pain in children and the diagnosis of appendicitis. West J Med 176:104–107PubMedGoogle Scholar
  11. 27.
    Passalaqua AM, Klein RL, Wegener WA et al (2004) Diagnosing suspected acute nonclassic appendicitis with sulesomab, a radiolabeled antigranulocyte antibody imaging agent. J Pediatr Surg 39:1338–1344PubMedCrossRefGoogle Scholar
  12. 28.
    Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881PubMedCrossRefGoogle Scholar
  13. 29.
    Stephen AE, Segev DL, Ryan DP et al (2003) The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT. J Pediatr Surg 38:367–71 discussion 367–371PubMedCrossRefGoogle Scholar
  14. 30.
    Yardeni D, Hirschl RB, Drongowski RA et al (2004) Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night. J Pediatr Surg 39:464–469 discussion 464–469PubMedCrossRefGoogle Scholar

Intussusception

  1. 31.
    Bajaj L, Roback MG (2003) Postreduction management of intussusception in a children’s hospital emergency department. Pediatrics 112:1302–1307PubMedCrossRefGoogle Scholar
  2. 32.
    Champoux AN, Del Beccaro MA, Nazar-Stewart V (1994) Recurrent intussusception. Risks and features. Arch Pediatr & Adolesc Med 148:474–478Google Scholar
  3. 33.
    Davis CF, McCabe AJ, Raine PA (2003) The ins and outs of intussusception: history and management over the past fifty years.. J Pediatr Surg 38:60–64PubMedCrossRefGoogle Scholar
  4. 34.
    DiFiore JW (1999) Intussusception:. Semin Pediatr Surg 8:214–220PubMedGoogle Scholar
  5. 35.
    Fischer TK, Bihrmann K, Perch M et al (2004) Intussusception in early childhood: a cohort study of 1.7 million children. Pediatrics 114:782–785PubMedCrossRefGoogle Scholar
  6. 36.
    Klein EJ, Kapoor D, Shugerman RP (2004) The diagnosis of intussusception. Clinical Pediatrics 43:343–347PubMedCrossRefGoogle Scholar
  7. 37.
    Kuppermann N, O’Dea T, Pinckney L et al (2000) Predictors of intussusception in young children. Arch Pediatr & Adolesc Med 154:250–255Google Scholar
  8. 38.
    Meradji M, Hussain SM, Robben SG et al (1994) Plain film diagnosis in intussusception. Br J Radiol 67:147–149PubMedCrossRefGoogle Scholar
  9. 39.
    Ratcliffe JF, Fong S, Cheong I et al (1992) Plain film diagnosis of intussusception: prevalence of the target sign:. Am J Roentgenol 158:619–621Google Scholar
  10. 40.
    Simon RA, Hugh TJ, Curtin AM (1994) Childhood intussusception in a regional hospital. Aust New Zeal J Surg 64:699–702PubMedCrossRefGoogle Scholar
  11. 41.
    Van Den Ende ED, Allema JH, Hazebroek FW et al (2005) Success with hydrostatic reduction of intussusception in relation to duration of symptoms:. Arch Dis Child 90:1071–1072 Epub 2005 Jun 7PubMedCrossRefGoogle Scholar
  12. 42.
    Weisz B, Reif S, Spirer Z (1994) [Intussusception in infants]. [Hebrew] Harefuah 126:704–707, 763Google Scholar

Analgesia and evaluation of abdominal pain

  1. 43.
    Yoon CH, Kim HJ, Goo HW (2001) Intussusception in children: US-guided pneumatic reduction—initial experience. Radiology 218:85–88PubMedGoogle Scholar
  2. 44.
    Bailey B, Bergeron S, Gravel J et al (2007) Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department. Ann Emerg Med 50:379–383 383.e1–2PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of Emergency MedicineChildren’s Hospital and Regional Medical CenterSeattleUSA

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