ACR Appropriateness Criteria® Back Pain-Child: 2024 Update.
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Nontraumatic back pain is a common chief complaint encountered in the pediatric population. Although there are many etiologies for pediatric back pain, most cases are attributable to benign mechanical causes. Serious conditions causing back pain such as inflammatory, infectious, and neoplastic etiologies are much less common but these pathologies can lead to long-term morbidity. Recent paradigm shift to judicious use of diagnostic imaging resources has come to the forefront. Although imaging is unlikely to be beneficial in transient back pain without neurologic deficit and normal physical examination, prompt imaging evaluation is required when there are clinical and laboratory findings suggesting an infectious or neoplastic etiology. For this document, various clinical scenarios are discussed by which a child may present with back pain. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are detailed. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.