OBJECTIVES: (1) Determine if older patients with abdominal pain who receive emergency department (ED) abdominal CT have changes in diagnosis and/or disposition more often than similar patients without CT; (2) compare physician confidence in diagnosis and disposition for patients with versus without CT; (3) document factors that most influence physician's decision to order abdominal CT in this population. METHODS: ED patients 60 years of age or older, with acute non-traumatic abdominal pain were enrolled over a 6-week period. Physicians documented a preliminary and final ED diagnosis and disposition, along with pre- and post-evaluation confidence levels. Decision to order CT, along with clinical information most influencing that decision, was noted. Physician confidence levels and percent change in diagnosis and disposition were compared for patients with versus without CT. RESULTS: One hundred and twenty-six patients comprised study sample. Abdominal CT rate was 59% (95%CI, 50-67%). CT was associated with an increased change in diagnosis (46%; 95%CI, 4-58% versus 29%; 95%CI, 16-42%), but no change in disposition between patients with versus without CT. Preliminary diagnostic confidence was lower for EPs who ordered a CT than for those who did not (p<0.001). Patient history most influenced ordering CT, whereas prior lab/imaging results most influenced not ordering CT. CONCLUSION: Patients with CT had a change in diagnosis more often than those without. Preliminary diagnostic confidence was lower in CT group. Percent change in disposition did not differ between groups. Physicians most often ordered CT based on history and did not order CT when other diagnostic evaluation supported a specific diagnosis.
OBJECTIVES: (1) Determine if older patients with abdominal pain who receive emergency department (ED) abdominal CT have changes in diagnosis and/or disposition more often than similar patients without CT; (2) compare physician confidence in diagnosis and disposition for patients with versus without CT; (3) document factors that most influence physician's decision to order abdominal CT in this population. METHODS: ED patients 60 years of age or older, with acute non-traumatic abdominal pain were enrolled over a 6-week period. Physicians documented a preliminary and final ED diagnosis and disposition, along with pre- and post-evaluation confidence levels. Decision to order CT, along with clinical information most influencing that decision, was noted. Physician confidence levels and percent change in diagnosis and disposition were compared for patients with versus without CT. RESULTS: One hundred and twenty-six patients comprised study sample. Abdominal CT rate was 59% (95%CI, 50-67%). CT was associated with an increased change in diagnosis (46%; 95%CI, 4-58% versus 29%; 95%CI, 16-42%), but no change in disposition between patients with versus without CT. Preliminary diagnostic confidence was lower for EPs who ordered a CT than for those who did not (p<0.001). Patient history most influenced ordering CT, whereas prior lab/imaging results most influenced not ordering CT. CONCLUSION:Patients with CT had a change in diagnosis more often than those without. Preliminary diagnostic confidence was lower in CT group. Percent change in disposition did not differ between groups. Physicians most often ordered CT based on history and did not order CT when other diagnostic evaluation supported a specific diagnosis.
Authors: Mehmet Selim Nural; Meltem Ceyhan; Ahmet Baydin; Selim Genc; Ilkay Koray Bayrak; Muzaffer Elmali Journal: Intern Emerg Med Date: 2008-04-29 Impact factor: 3.397
Authors: Wytze Laméris; Adrienne van Randen; H Wouter van Es; Johannes P M van Heesewijk; Bert van Ramshorst; Wim H Bouma; Wim ten Hove; Maarten S van Leeuwen; Esteban M van Keulen; Marcel G W Dijkgraaf; Patrick M M Bossuyt; Marja A Boermeester; Jaap Stoker Journal: BMJ Date: 2009-06-26
Authors: Ekin Ozturk; Marianne van Iersel; Martijn Mwj Stommel; Yvonne Schoon; Richard Rpg Ten Broek; Harry van Goor Journal: World J Emerg Surg Date: 2018-10-20 Impact factor: 5.469