Leslie K Lee1,2, Andrew T Reisner3, William D Binder3,4, Atif Zaheer5, Martin L Gunn6, Ken F Linnau6, Chad M Miller7, Maurice S Herring1,8,9, Angela C Tramontano8, Avinash Kambadakone1, Onofrio A Catalano1, Mukesh Harisinghani1, Elkan F Halpern1,8, Karen Donelan10, G Scott Gazelle1,8, Pari V Pandharipande1,8. 1. 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. 2. 2 Present address: Department of Radiology, Brigham and Women's Hospital, Boston, MA. 3. 3 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. 4. 4 Present address: Department of Emergency Medicine, Brown University, Providence, RI. 5. 5 Department of Radiology, Johns Hopkins University, Baltimore, MD. 6. 6 Department of Radiology, University of Washington, Seattle, WA. 7. 7 Department of Radiology, Duke University Medical Center, Durham, NC. 8. 8 Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA. 9. 9 Present address: Cedars Sinai Medical Center, Los Angeles, CA. 10. 10 Department of Medicine, Mongan Institute for Health Policy Center, Massachusetts General Hospital, Boston, MA.
Abstract
OBJECTIVE: The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. SUBJECTS AND METHODS: Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. RESULTS: The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). CONCLUSION: Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.
OBJECTIVE: The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. SUBJECTS AND METHODS: Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. RESULTS: The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). CONCLUSION: Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.
Entities:
Keywords:
CT; abdominal pain; emergency medicine; health policy; resource utilization
Authors: Thi Ninh Ha; Sviatlana Kamarova; David Youens; Cameron Wright; Donald McRobbie; Jenny Doust; John Slavotinek; Max K Bulsara; Rachael Moorin Journal: BMJ Open Date: 2022-06-01 Impact factor: 3.006