Alter SM, et al. - In this work, researchers aimed at assessing whether radiology report "disclaimers" increase the use of abdominal CT in the work-up of pediatric abdominal pain. As per observations, appendix ultrasound interpretations frequently included a disclaimer, which resulted in a 150% increase in follow-up CT imaging. They suggested radiologists consider the impact of including such a disclaimer, knowing that this could lead to possible unnecessary imaging.

Methods

• This is a retrospective cohort study performed at Community emergency department (ED) with volume of 85,000 annual visits.
• Researchers included consecutive ED patients <21-years-old with appendix U/S over 12-months.
• Assessment was performed of radiologist reports for disclaimers and if definitive diagnoses of appendicitis were made.
• They determined the incidence of subsequent CT imaging and calculated group differences between categories.

Results

• Researchers identified 441 eligible patients; median age was 11.7 years.
• For appendicitis, 26% of all U/S studies were definitive and 74% were non-definitive.
• On 60% of all studies, disclaimers were included, these included 13% of definitive studies and 76% of non-definitive studies.
• Findings revealed that 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% indicated follow-up CT with no marked difference between groups with or without a disclaimer.
• For patients with non-definitive studies, 26% with a disclaimer indicated follow-up CT scans versus 13% without a disclaimer (13% difference; 95% CI: 4–22).