Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults

OBJECTIVE. Our purpose was to evaluate the impact of sonographic data on cl inical physicians' diagnostic confidence and their treatment of children an d young adults with acute lower abdominal pain. SUBJECTS AND METHODS. Senior surgical and emergency department staff comple ted questionnaires before and after abdominal sonography was performed on 9 4 of 101 consecutive children and young adults with acute lower abdominal p ain, pelvic pain, or both. Physicians who were unaware of sonographic data stated the most likely diagnosis and their level of confidence in their dia gnosis and then formulated clinical plans. After they were given sonographi c data, physicians again stated the most likely diagnosis, estimated their level of confidence, and formulated revised treatment plans. RESULTS. Sonographic data resulted in revised clinical diagnoses in 52% of the patients. Overall, the gain in diagnostic confidence for the entire stu dy population was 33% (95% confidence interval [CI], 27-38%; p < .0001). Th e impact on the physicians' confidence was greater in those children and yo ung adults whose diagnoses changed after sonography (mean increase in physi cians' confidence, 48.3%; 95% CI, 47-75%). In patients whose diagnoses were not changed after sonography, the mean increase in physicians' confidence was 17.6% (95% CI, 11-24%; p < .0001 [analysis of variance]). Physicians us ed sonographic data to change initial treatment plans in 43 patients (46%). Of these 43 patients, a lower intensity of care was given to 30 patients ( 70%) and a higher intensity to 13 patients (30%). CONCLUSION. Sonographic data frequently changed initial clinical diagnoses, thus increasing diagnostic confidence and changing clinical treatment deci sions in the setting of acute lower abdominal pain in children and young ad ults.