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Objective: Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a "disclaimer" is associated with additional imaging., Methods: Design: Retrospective cohort., Setting: Community ED with volume of 85,000 annual visits., Population: Consecutive ED patients <21-years-old with appendix U/S over 12-months. Radiologist reports were assessed for disclaimers and if definitive diagnoses of appendicitis were made. The incidence of subsequent CT imaging was determined and group differences between categories were calculated., Results: 441 eligible patients were identified with average age 11.7years. Of all U/S studies, 26% were definitive for appendicitis and 74% were non-definitive. Disclaimers were included on 60% of all studies, including 13% of definitive studies and 76% of non-definitive studies. 25% of all studies including a disclaimer had follow-up CT versus 10% of studies without a disclaimer (15% difference; 95% CI: 9-21). For patients with definitive interpretations, 6% had follow-up CT with no significant difference between groups with or without a disclaimer. For patients with non-definitive studies, 26% with a disclaimer had follow-up CT scans versus 13% without a disclaimer (13% difference; 95% CI: 4-22)., Conclusions: Appendix ultrasound interpretations often include a disclaimer, which leads to a 150% increase in follow-up CT imaging. We suggest that radiologists consider the impact of including such a disclaimer, knowing that this may contribute to possible unnecessary imaging., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Radiation concerns are changing the way emergency physicians evaluate patients. This is especially prevalent in pediatrics, and exemplified by abdominal pain management. Large academic center-based studies suggest appendix ultrasound (U/S) is sensitive and specific for appendicitis, with low nondiagnostic rates., Objectives: We sought to determine the diagnostic rate of appendix U/S and incidence of follow-up computed tomography (CT) imaging for pediatric patients at a community hospital., Methods: Design: Retrospective cohort., Setting: Emergency department with 85,000 annual visits., Population: Patients younger than 21 years old that had an appendix U/S over a 12-month period. U/S were performed by technicians and interpreted by radiologists. Investigators classified readings as "diagnostic" ("positive" and "negative") or "non-diagnostic" ("borderline" and "appendix not visualized") and identified follow-up CT studies and interpretations., Results: There were 441 pediatric appendix U/S performed; 26% were diagnostic (14% positive for appendicitis, 12% negative) and 74% nondiagnostic (5% borderline, 69% appendix not visualized). Follow-up CT scans were obtained in 19% of all patients, including 8% with positive U/S, 4% negative, 32% borderline, and 22% not visualized. Follow-up CT was nearly four times more likely in the nondiagnostic group than the diagnostic group (23% vs. 6%, p < 0.0001)., Conclusion: The utility of U/S to diagnose appendicitis at a community hospital is limited by a high rate of nondiagnostic studies. Some patients with diagnostic U/S even had follow-up CT imaging. To minimize radiation exposure in children, improvements should be made in the performance and acceptance of U/S as the primary modality of abdominal pain imaging at community hospitals., (Copyright © 2017 Elsevier Inc. All rights reserved.)