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Rofo 2023; 195(03): 205-216
DOI: 10.1055/a-1948-1380
Review

Acute care diagnostics in children for general radiologists – not alone in the hospital at night

Article in several languages: English | deutsch
Meinrad Beer
1   Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
,
Hans-Joachim Mentzel
2   Department of Radiology/Division of Paediatric Radiology, Jena University Hospital, Jena, Germany
3   President, German Society for Pediatric Radiology, Jena, Germany
,
Marc Steinborn
4   Institute for Diagnostic and Interventional Radiology and Pediatric Radiology, Munich Municipal Hospital Group, Munchen, Germany
,
Matthias Cornelius Schaal
1   Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
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Abstract

Background Radiologic care for children and adolescents during night and weekend shifts is challenging. This is especially true when a dedicated pediatric radiology front or background service is not available.

Methods The purpose of this review is to present the approach, the most relevant diagnoses, and their differential diagnoses based on four common example cases – abdominal pain, respiratory/chest pain, headache, and refusal to walk. Essentials such as clinical classification (e. g., disease dynamics) and practical instructions (e. g., necessity of acute cross-sectional imaging) are presented.

Results and Conclusion For the abdomen, appendicitis ranks first among acute diseases. Other important diseases are intussusception and volvulus. Far more frequently, however, gastroenteritis is the cause of abdominal pain. Usually no imaging is required in this case. In unclear clinical situations, ultrasound may be indicated. In suspected pulmonary infections, chest imaging is limited to inconclusive cases and suspicion of complications such as pleural empyema. Major emergencies include (spontaneous) pneumothorax and aspiration. Headache is a common symptom. Immediate imaging is only necessary in cases of suspected acute inflammatory (meningitis/encephalitis) or vascular disease (e. g., hemorrhage due to vascular malformations). MRI is the primary imaging modality in these cases. Restricted walking/refusal to walk is a classic nonspecific sign, particularly of acute musculoskeletal disease, especially in younger children. Clinical examination is essential to narrow down the field of investigation. Besides the frequent and symptomatic coxitis fugax, the rare but serious (septic) arthritis/osteomyelitis must not be overlooked.

Key Points: 

  • Radiological care of children and adolescents is challenging, especially during night and weekend shifts.

  • However, in close cooperation with the referring colleagues/clinics, the appropriate approach can be effectively determined even if the symptoms are not clear.

  • The selection of the optimal imaging method is based on guidance and guidelines, but also on the condition of the child/adolescent.

  • A silent or whimpering child is cause for alarm.

Citation Format

  • Beer M, Mentzel H, Steinborn M et al. Acute care diagnostics in children for general radiologists – not alone at night in the hospital. Fortschr Röntgenstr 2023; 195: 205 – 216

Key words

children - injuries - imaging sequences - decision analysis


Publication History

Received: 25 February 2022

Accepted: 18 August 2022

Article published online:
19 October 2022

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