RACP Paediatrics & Child Health Division
Recommendations from the RACP's Paediatrics & Child Health Division on antibiotic use, bronchiolitis, asthma diagnosis, GORD treatment and abdominal x-rays. The Paediatrics & Child Health Division represents 4,500 Fellows and Trainees of The Royal Australasian College of Physicians (RACP). We aim to improve the health and wellbeing of neonates, infants and children as well as adolescents and young adults (known as young people) through education and training, research, and policy and advocacy.
Do not routinely order abdominal X-rays for the diagnosis of non-specific abdominal pain in children
Retrospective studies of medical records of children and adults admitted for constipation and other forms of non-specific abdominal pain conclude that in only a very small minority (under 5%) of cases do abdominal X-rays make a difference in patient treatment. A recent study also showed that abdominal X-rays were performed more frequently in misdiagnosed children. Numerous studies yield significantly varying estimates of the sensitivity and specificity of abdominal x-rays and insufficient evidence of a diagnostic association between symptoms of constipation and faecal loading seen on abdominal X-rays. There is significant scope for reducing the number of abdominal X-rays performed without sacrificing diagnostic accuracy for children with abdominal pain.
- Berger MY, Tabbers MM, Kurver MJ, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. Journal of Pediatrics 2012; 161(1):44-50.
- Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. Journal of Pediatrics 2014; 164(1):83-88.
- Kellow Z, MacInnes M, Kurzencwyg D, et al. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 2008; 248(3):887-93.
The Paediatrics & Child Health Division (PCHD) formed a group of interested Fellows to comprise a General Paediatrics EVOLVE Working Group. A review of low-value practices relevant to general paediatrics was conducted drawing on lists published by Choosing Wisely US and Canada, contributions to Choosing Wisely Australia by other medical colleges and published EVOLVE lists developed by other specialties in order to identify low-value practices of relevance while avoiding duplicating the mention of practices already identified in other EVOLVE lists. Based on this review, the Working Group shortlisted 15 items for further consideration.
These 15 items were then reviewed and discussed by participants at a workshop held at the RACP Annual Congress 2016. Following these deliberations, the list was further narrowed down to 10 items. These 10 items were incorporated into an online survey which also summarised the recent evidence on each of these items. A link to the survey was distributed to all Fellows and advanced trainees of the RACP Paediatrics & Child Health Division.
Survey respondents were asked whether they agreed, disagreed or were unsure about whether each item was undertaken in a significant number of paediatric patients, whether there was good evidence that the item should be undertaken less often and whether reducing use of the item was important in terms of reducing harm and/or costs to the healthcare system. Each item was assigned a score based on respondents’ answers to these three questions on each item. There were 269 respondents representing a survey response rate of approximately 22 per cent. The five highest scoring items were selected to be on this ‘top-five’ list.
- 1 Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection
- 2 Do not routinely undertake chest X-rays for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children
- 3 Do not routinely order chest X-rays for the diagnosis of asthma in children
- 4 Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
- 5 Do not routinely order abdominal X-rays for the diagnosis of non-specific abdominal pain in children