Aaron Nathan Barksdale1, Jeff Lee Hackman2, Monica Gaddis3, Matt Christopher Gratton3. 1. Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: aaron.barksdale@unmc.edu. 2. Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. 3. Department of Emergency Medicine, Truman Medical Center/UMKC School of Medicine, Kansas City, MO.
Abstract
OBJECTIVES: To determine the effect of abdominal computed tomographic (CT) scan results on diagnosis and disposition of patients with non-traumatic abdominal pain who were evaluated by board-certified emergency physicians (EPs). METHODS: Prospective, observational study conducted at a safety-net facility with an emergency medicine residency and 65000 annual adult visits. Patients with non-traumatic abdominal pain who underwent an abdominal CT from 3/2011 through 8/2011 were included. Decision to obtain CT was made by the EP. The computer order entry system required the EP to report the most likely diagnosis, and the management and disposition plan. After CT results, the same EP electronically again entered the most likely diagnosis and the planned management and disposition. CTs were interpreted by an attending radiologist. Descriptive statistics and χ(2) tests were used. RESULTS: Six hundred twenty-nine patients were entered and 547 remained after exclusions; 298 (54%) subjects had a change in diagnosis. In 6 categories, there was a statistically significant change, with non-specific abdominal pain the most common(P < .001); followed by renal colic (P < .001), appendicitis (P < .001), diverticulitis (P < .001), small bowel obstruction (P < .029), and gynecologic process (P < .001). The most common disposition plan was "admit for observation," which was reported in 262 patients and remained in only 122 post CT (47%); 301 (54%) patients whose initial plan was admission were ultimately managed otherwise. CONCLUSIONS: Abdominal CT use by board certified EPs for nontraumatic abdominal pain changed diagnosis and disposition, with more sent home in lieu of admission. Diagnostic accuracy did not appear to be related to years of clinical experience.
OBJECTIVES: To determine the effect of abdominal computed tomographic (CT) scan results on diagnosis and disposition of patients with non-traumatic abdominal pain who were evaluated by board-certified emergency physicians (EPs). METHODS: Prospective, observational study conducted at a safety-net facility with an emergency medicine residency and 65000 annual adult visits. Patients with non-traumatic abdominal pain who underwent an abdominal CT from 3/2011 through 8/2011 were included. Decision to obtain CT was made by the EP. The computer order entry system required the EP to report the most likely diagnosis, and the management and disposition plan. After CT results, the same EP electronically again entered the most likely diagnosis and the planned management and disposition. CTs were interpreted by an attending radiologist. Descriptive statistics and χ(2) tests were used. RESULTS: Six hundred twenty-nine patients were entered and 547 remained after exclusions; 298 (54%) subjects had a change in diagnosis. In 6 categories, there was a statistically significant change, with non-specific abdominal pain the most common(P < .001); followed by renal colic (P < .001), appendicitis (P < .001), diverticulitis (P < .001), small bowel obstruction (P < .029), and gynecologic process (P < .001). The most common disposition plan was "admit for observation," which was reported in 262 patients and remained in only 122 post CT (47%); 301 (54%) patients whose initial plan was admission were ultimately managed otherwise. CONCLUSIONS: Abdominal CT use by board certified EPs for nontraumatic abdominal pain changed diagnosis and disposition, with more sent home in lieu of admission. Diagnostic accuracy did not appear to be related to years of clinical experience.