M Barat1, A Paisant2, P Calame3, Y Purcell4, M Lagadec4, S Curac5, M Zappa4, V Vilgrain6, M Ronot6. 1. Department of Radiology, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110 Clichy, France. Electronic address: maxime.barat@aphp.fr. 2. Department of Radiology, CHU d'Angers, 49000 Angers, France. 3. Department of Radiology, CHU de Besançon, 25000 Besançon, France. 4. Department of Radiology, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110 Clichy, France. 5. Department of Emergency Medicine, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110 Clichy, France. 6. Department of Radiology, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110 Clichy, France; Université Paris 5-Diderot, Sorbonne Paris Cité, 75006 Paris, France; INSERM U1149, CRI, 75010 Paris, France.
Abstract
PURPOSE: The purpose of this study was to compare the diagnostic accuracy and inter-reader agreement of unenhanced computed tomography (CT) to those of contrast-enhanced CT for triage of patients older than 75years admitted to emergency department (ED) with acute abdominal pain (AAP). PATIENTS AND METHODS: Two hundred and eight consecutive patients presenting with AAP to the ED who underwent CT with unenhanced and contrast-enhanced images were retrospectively included. There were 90 men and 118 women with a mean age of 85.4±4.9 (SD) (range: 75-101.4years). Three readers reviewed unenhanced CT images first, and then unenhanced and contrast-enhanced CT images as a single set. Diagnostic accuracy was compared to the standard of reference defined as the final diagnosis obtained after complete clinico-biological and radiological evaluation. Correctness of the working diagnosis proposed by the ED physician was evaluated. Intra- and inter-reader agreements were calculated using the kappa test and interclass correlation. Subgroup analyses were performed for patients requiring only conservative management and for those requiring intervention. RESULTS: Diagnostic accuracy ranged from 64% (95% CI: 62-66%) to 68% (95% CI: 66-70%) for unenhanced CT, and from 68% (95% CI: 66-70%) to 71% (95% CI: 69-73%) for both unenhanced and contrast-enhanced CT. Contrast-enhanced CT did not significantly improve the diagnostic accuracy (P=0.973-0.979). CT corrected the working diagnosis proposed by the ED physician in 59.1% (range: 58.1-60.0%) and 61.2% (range: 57.6-65.5%) of patients before and after contrast injection (P>0.05). Intra-observer agreement was moderate to substantial (k=0.513-0.711). Inter-reader agreement was substantial for unenhanced (kappa=0.745-0.789) and combined unenhanced and contrast-enhanced CT (kappa=0.745-0.799). Results were similar in subgroup analyses. CONCLUSION: Unenhanced CT alone is accurate and associated with high degrees of inter-reader agreement for clinical triage of patients older than 75years with AAP in the emergency setting.
PURPOSE: The purpose of this study was to compare the diagnostic accuracy and inter-reader agreement of unenhanced computed tomography (CT) to those of contrast-enhanced CT for triage of patients older than 75years admitted to emergency department (ED) with acute abdominal pain (AAP). PATIENTS AND METHODS: Two hundred and eight consecutive patients presenting with AAP to the ED who underwent CT with unenhanced and contrast-enhanced images were retrospectively included. There were 90 men and 118 women with a mean age of 85.4±4.9 (SD) (range: 75-101.4years). Three readers reviewed unenhanced CT images first, and then unenhanced and contrast-enhanced CT images as a single set. Diagnostic accuracy was compared to the standard of reference defined as the final diagnosis obtained after complete clinico-biological and radiological evaluation. Correctness of the working diagnosis proposed by the ED physician was evaluated. Intra- and inter-reader agreements were calculated using the kappa test and interclass correlation. Subgroup analyses were performed for patients requiring only conservative management and for those requiring intervention. RESULTS: Diagnostic accuracy ranged from 64% (95% CI: 62-66%) to 68% (95% CI: 66-70%) for unenhanced CT, and from 68% (95% CI: 66-70%) to 71% (95% CI: 69-73%) for both unenhanced and contrast-enhanced CT. Contrast-enhanced CT did not significantly improve the diagnostic accuracy (P=0.973-0.979). CT corrected the working diagnosis proposed by the ED physician in 59.1% (range: 58.1-60.0%) and 61.2% (range: 57.6-65.5%) of patients before and after contrast injection (P>0.05). Intra-observer agreement was moderate to substantial (k=0.513-0.711). Inter-reader agreement was substantial for unenhanced (kappa=0.745-0.789) and combined unenhanced and contrast-enhanced CT (kappa=0.745-0.799). Results were similar in subgroup analyses. CONCLUSION: Unenhanced CT alone is accurate and associated with high degrees of inter-reader agreement for clinical triage of patients older than 75years with AAP in the emergency setting.
Authors: Paola Fugazzola; Marco Ceresoli; Federico Coccolini; Francesco Gabrielli; Alessandro Puzziello; Fabio Monzani; Bruno Amato; Gabriele Sganga; Massimo Sartelli; Francesco Menichetti; Gabriele Adolfo Puglisi; Dario Tartaglia; Paolo Carcoforo; Nicola Avenia; Yoram Kluger; Ciro Paolillo; Mauro Zago; Ari Leppäniemi; Matteo Tomasoni; Lorenzo Cobianchi; Francesca Dal Mas; Mario Improta; Ernest E Moore; Andrew B Peitzman; Michael Sugrue; Vanni Agnoletti; Gustavo P Fraga; Dieter G Weber; Dimitrios Damaskos; Fikri M Abu-Zidan; Imtiaz Wani; Andrew W Kirkpatrick; Manos Pikoulis; Nikolaos Pararas; Edward Tan; Richard Ten Broek; Ronald V Maier; R Justin Davies; Jeffry Kashuk; Vishal G Shelat; Alain Chicom Mefire; Goran Augustin; Stefano Magnone; Elia Poiasina; Belinda De Simone; Massimo Chiarugi; Walt Biffl; Gian Luca Baiocchi; Fausto Catena; Luca Ansaloni Journal: World J Emerg Surg Date: 2022-01-21 Impact factor: 5.469