Links To 2018 “ACR Appropriateness Criteria: Acutely Limping Child Up To Age 5”

As always my posts are simply my study notes (peripheral brain) to help me retain my learning and reviews.

This post has links to the outstanding ACR Appropriateness Criteria: Acutely Limping Child Up To Age [PubMed Abstract] [Full Text HTML] [Full Text PDF]. J Am Coll Radiol. 2018 Nov;15(11S):S252-S262. doi: 10.1016/j.jacr.2018.09.030.

For me, the key to using the great ACR resources* for imaging medical decision making, is to review the Appropriate Use Criteria for the clinical situation I’m evaluating. I find that the relevant ACR Appropriateness Criteria provides an excellent way for me to check my thinking, especially if it has been a while since I’ve encountered a given clinical situation. I use the PDF version when I’m doing a quick review.

*Here is the link to the most current complete list of the American College of Radiology Appropriateness Criteria. All the Appropriateness Criteria on this list are PDFs which is, I think, best for rapid review.

I’ve included below the abstract (after the outline) and the article outline of the HTML version of the article which has live links to the various sections:

Article Outline

1. Summary of Literature Review
   1. Introduction/Background
2. Discussion of Procedures by Variant
   1. Variant 1: Child Up to Age 5. Acute Limp. Nonlocalized Symptoms. No Concern for Infection. Initial Imaging
      1. Radiography Lower Extremities
      2. US Hips or Lower Extremity
      3. Tc-99m 3-Phase Bone Scan Whole-Body
      4. CT Lower Extremity
      5. MRI Lower Extremity
      6. MRI Whole-Body
   2. Variant 2: Child Up to Age 5. Acute Limp. Pain. Localized Symptoms. No Concern for Infection. Initial Imaging
      1. Radiography Lower Extremity
      2. US Hips or Lower Extremity
      3. Tc-99m 3-Phase Bone Scan Whole-Body
      4. CT Lower Extremity
      5. MRI Lower Extremity
   3. Variant 3: Child Up to Age 5. Acute Limp. Nonlocalized Symptoms. Concern for Infection. Initial Imaging
      1. Radiography Lower Extremities
      2. US Hips or Lower Extremity
      3. Tc-99m 3-Phase Bone Scan Whole-Body
      4. MRI Lower Extremity
      5. MRI Whole-Body
      6. CT Lower Extremity
   4. Variant 4: Child Up to Age 5. Acute Limp. Symptoms Localized to the Hip. Concern for Infection. Initial Imaging
      1. Radiography Pelvis or Lumbar Spine
      2. US Hips
      3. Tc-99m 3-Phase Bone Scan Whole-Body
      4. CT Pelvis
      5. MRI Pelvis
   5. Variant 5: Child Up to Age 5. Acute Limp. Symptoms Localized to Lower Extremity (Not Pelvis or Hips). Concern for Infection. Initial Imaging
      1. Radiography Lower Extremity
      2. US Lower Extremity
      3. Tc-99m 3-Phase Bone Scan Whole-Body
      4. CT Lower Extremity
      5. MRI Lower Extremity
      6. MRI Whole-Body
3. Other Diagnoses
4. Summary of Recommendations
5. Summary of Evidence
6. Relative Radiation Level Information
7. Supporting Documents
8. References

Abstract

Imaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspicion for infection and whether symptoms can be localized. The appropriateness of specific imaging examinations in the acutely limping child to age 5 years is discussed with attention in each clinical scenario to the role of radiography, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. Common causes of limping such as toddler’s fracture, septic arthritis, transient synovitis, and osteomyelitis are discussed.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.