Kirsten J de Burlet1,2, Matthew MacKay3, Peter Larsen2, Elizabeth R Dennett1,2. 1. 1 Department of General Surgery, Capital and Coast DHB , Wellington , New Zealand. 2. 2 Department of Surgery and Anaesthesia, University of Otago , Wellington , New Zealand. 3. 3 Department of Radiology, Capital and Coast DHB , Wellington , New Zealand.
Abstract
OBJECTIVE: Acute abdominal pain is the most common reason for surgical admission. CT scans are increasingly used to aid early diagnosis. Excessive use of CT scans is associated with increased length of stay, healthcare costs and radiation. The aim of this study was to evaluate the appropriateness of CT scans for patients presenting with acute abdominal pain. METHODS: We examined 100 consecutive patients presenting with new acute abdominal pain who underwent a CT scan. Clinical information available at the time the scan was ordered, was summarised and reviewed independently by five consultant general surgeons and five consultant radiologists. RESULTS: A CT scan was judged to be not indicated in a median of 21% of cases (range 12-53%), more information was required in a median of 16% (0-41%) and in a median of 58% (37-88%) the CT scan was considered indicated. There was a good level of agreement (Cronbach's α 0.704) across the 10 experts. CONCLUSION: These data suggest that a large proportion of CT scans for patients with acute abdominal pain are not clinically indicated or are being performed prior to adequate clinical work-up. Optimising CT scan requests for this patient group will improve use of healthcare resources. Advances in knowledge: Both radiologists and general surgeons agree that there is no indication for an abdominal CT scan for a patient presenting with acute abdominal pain in a median of 21% of the cases.
OBJECTIVE: Acute abdominal pain is the most common reason for surgical admission. CT scans are increasingly used to aid early diagnosis. Excessive use of CT scans is associated with increased length of stay, healthcare costs and radiation. The aim of this study was to evaluate the appropriateness of CT scans for patients presenting with acute abdominal pain. METHODS: We examined 100 consecutive patients presenting with new acute abdominal pain who underwent a CT scan. Clinical information available at the time the scan was ordered, was summarised and reviewed independently by five consultant general surgeons and five consultant radiologists. RESULTS: A CT scan was judged to be not indicated in a median of 21% of cases (range 12-53%), more information was required in a median of 16% (0-41%) and in a median of 58% (37-88%) the CT scan was considered indicated. There was a good level of agreement (Cronbach's α 0.704) across the 10 experts. CONCLUSION: These data suggest that a large proportion of CT scans for patients with acute abdominal pain are not clinically indicated or are being performed prior to adequate clinical work-up. Optimising CT scan requests for this patient group will improve use of healthcare resources. Advances in knowledge: Both radiologists and general surgeons agree that there is no indication for an abdominal CT scan for a patient presenting with acute abdominal pain in a median of 21% of the cases.
Authors: Aaron Sodickson; Pieter F Baeyens; Katherine P Andriole; Luciano M Prevedello; Richard D Nawfel; Richard Hanson; Ramin Khorasani Journal: Radiology Date: 2009-04 Impact factor: 11.105