Aim: We aimed to put forward the efficacy of abdominal CT performed for patients diagnosed with acute abdomen and to share our clinical findings in that regard.
Methods: 216 patients who had been hospitalized in General Surgery Department due to acute abdomen had been analyzed retrospectively between October 2018 - January 2019. Abdominal computerized tomography (CT) results had been discussed in terms of diagnostic accuracy and clinical outcomes.
Results: 171 (79.2%) patients (M/F:95/76 (55.6% / 44.4%)) had been evaluated by computerized tomography (CT) due to various causes of acute abdomen. Patients who had been scanned more than once (n=13 (7.6%)) during theirs’ hospitalization period had longer average length of stays compared to those whom had been scanned for only once (n=158 (92.4%)) (multiple scanned:17 days vs single scanned:3 days; p=0.000). Besides, single-scanned patients had showed higher clinical accuracy compared to those with multi-scans (80.4% vs 61.5%, p=0.126). 28 ileus (84.8%) patients had been scanned by non-enteral computerized tomography (CT), and 12 (36.4%) of them had been given false radiological reviews.
Conclusion: Improper and redundant use of computerized tomography (CT) may cause prolongation of stays at the hospital, besides performing unnecessary scans do not improve diagnostic accuracy.
2. Stoker J, Van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology 2009; 253: 31–46.
3. Foinant M, Lipiecka E, Buc E, Boire JY, Schmidt J, Garcier JM, et al. Impact of computed tomography on patient’s care in nontraumatic acute abdomen: 90 patients. J Radiol 2007; 88: 559–65.
4. Esses D, Birnbaum A, Bijur P, Shah S, Gleyzer A, Gallagher EJ. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 2016; 26: 1766–74.
5. Esses D, Birnbaum A, Bijur P, Shah S, Gleyzer A, Gallagher EJ. Ability of CT to alter decision making in elderly patients with acute abdominal pain. The American Journal of Emergency Medicine 2004; 22: 270–2.
6. Salem TA, Molloy RG, O’Dwyer PJ. Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Disease 2005; 7:460–6.
7. Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, et. Al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167: 700-7.
8. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et. Al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: A retrospective cohort study. Lancet 2012 ;380: 499-505.
9. Fenton SJ, Hansen KW, Meyers RL, Vargo DJ, White KS, Firth SD, et al. CT scan and the pediatric trauma patient--are we overdoing it? J Pediatr Surg 2004; 39:1877-81.
10. Schuur JD, Chu G, Sucov A. Effect of oral contrast for abdominal computed tomography on emergency department length of stay. Emerg Radiol 2010; 17: 267–273.
11. Levenson RB, Camacho MA, Horn E, Saghir A, McGillicuddy D, Sanchez LD. Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis. Emerg Radiol 2012; 19: 513–7.
12. Razavi SA, Johnson J-O, Kassin MT, Applegate KE. The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turnaround times, emergency department length of stay, and patient safety. Emerg Radiol 2014; 21: 605–13.
13. Kammerer S, Höink AJ, Wessling J, Heinzow H, Koch R, Schuelke C, et al. Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study. Eur Radiol 2015; 25:669–78.
14. Uyeda JW, Yu H, Ramalingam V, Devalapalli AP, Soto JA, Anderson SW. Evaluation of acute abdominal pain in the emergency setting using computed tomography without oral contrast in patients with body mass index greater than 25. J Comput Assist Tomogr 2015;39:681–86.
15. Radwan RW, Tang AM, Beasley WD. Computed tomography as a first-line investigation for elderly patients admitted to a surgical assessment unit. Ann R Coll Surg Engl 2018; 100: 285-9.
16. Gans SL, Pols MA, Stoker J, Boermeester MA; expert steering group. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Dig Surg 2015; 32: 23-31.
17. Hustey FM, Meldon SW, Banet GA, Gerson LW, Blanda M, Lewis LM. The use of abdominal computed tomography in older ED patients with acute abdominal pain. The American Journal of Emergency Medicine 2005; 23: 259–65.
18. Subramaniam RM, Kurth DA, Waldrip CA, Rybicki FJ. American College of Radiology Appropriateness Criteria: Advancing Evidence-Based Imaging Practice. Semin Nucl Med 2019; 49: 161-5.
19. De Simone B, Ansaloni L, Sartelli M, Gaiani F, Leandro G, De' Angelis GL, et al. Is the risk of contrast-induced nephropathy a real contraindication to perform intravenous contrast enhanced Computed Tomography for non traumatic acute abdomen in EmergencySurgery Department? Acta Biomed 2018; 89: 158-72.
20. Kidoh M1, Nakaura T, Awai K, Matsunaga Y, Tanoue K, Harada K, et al. Low-contrast dose protection protocol for diagnostic computed tomography in patients at high-risk for contrast-induced nephropathy. J Comput Assist Tomogr 2013; 37: 289-96.
21. Anderson SW, Soto JA. Multi-detector row CT of acute non-traumatic abdominal pain: contrast and protocol considerations. Radiol Clin North Am 2012; 50: 137–47.
22. Broder JS, Hamedani AG, Liu SW, Emerman CL. Emergency department contrast practices for abdominal/pelvic computed tomography-a national survey and comparison with the American College of Radiology Appropriateness Criteria. J Emerg Med 2013; 44: 423–33.
23. Kielar AZ, Patlas MN, Katz DS. Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role? Emerg Radiol 2016; 23: 477-81.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.