January 24, 2011 — A change in diagnosis and treatment was made in nearly half (49%) of adult patients presenting to an emergency department with nontraumatic abdominal pain after a computed tomography (CT) scan, according to a prospective study of 584 patients at the Massachusetts General Hospital in Boston between November 2006 and February 2008.
The results support the utility of CT scans, despite concerns about associated increases in cost and radiation exposure, researchers said.
Results of the study appear in the February 2011 issue of the American Journal of Roentgenology.
The use of CT scans was associated with a reduction in the number of patients admitted to the hospital by nearly half. In addition, the imaging technique was associated with an increase in the level of physician confidence in their diagnosis to 92.2%, up from 70.5%.
Prior to the CT scan, physicians planned to admit 75.3% of the patients evaluated (440 of 584 patients). After CT, the plan was changed to discharge with follow-up in 106 of 440 cases (24.1%), Hani H. Abujudeh, MD, and colleagues report. There was a 126% increase in the diagnosis of "no acute condition" after a CT.
Surgery was initially planned in 79 patients, but after CT, 20 patients (25.3%) were discharged.
The use of CT also reduced the number of patients for whom observation was planned by 44% (from 117 to 66 patients), and increased the number of patients discharged by 55% (from 142 to 220 patients).
Dr. Abujudeh and colleagues also found that treatment was upgraded to admission for some patients, even though the initial treatment plan was discharge. Prior to CT, physicians planned to discharge 142 patients, but the treatment plan was changed to admission in 29 patients (20.4%), they say. Overall, the use of CT reduced planned admission by 17.5%.
The researchers only analyzed data from adults who presented to the emergency department during the hours covered by the study coordinator, which varied between 3:00 PM and midnight Monday through Friday, and who underwent an abdominal CT scan as part of their work-up, the authors note. The patients had a mean age of 53.5 years.
The study was thought to be more powerful than some previous studies, which excluded conditions such as intraabdominal malignancies and inflammatory bowel disease, according to the authors. However, the study had weaknesses, they say. For instance, the research took place at a teaching hospital, so the findings might not be generalizable to other institutions.
AJR. 2011;196:238-243.
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Cite this: John Otrompke. Abdominal CT Scans Improve Diagnostic Certainty in the ED - Medscape - Jan 24, 2011.
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