Criteria for performing plain abdominal radiographs in patients with abdominal pain:
(1) moderate or severe tenderness
(2) high clinical suspicion of bowel obstruction
(3) high clinical suspicion of renal/ureteral calculi
(4) high clinical suspicion of trauma
(5) high clinical suspicion of ischemia
(6) high clinical suspicion of gallstones, if ultrasound is unavailable
Situations (without any of the above criteria) where plain abdominal films had a low likelihood of showing an abnormality:
(1) history of ulcer disease
(2) mild abdominal pain
(3) abdominal pain for more than a week
Consequences of criteria use:
(1) reduction in X-ray examinations by about half (54% in study population)
(2) all serious pathologic processes with radiographic abnormalities would be detected
(3) a small percentage (3.5%) of radiographic abnormalities would not have been detected, but these were of with limited significance and almost all were related to localized or generalized ileus.
Limitations:
• The study was done before widespread availability of CT scanning.
