Acute Nontraumatic Abdominal Pain in Adult Patients: Abdominal Radiography Compared with CT Evaluation1 (original) (raw)
Related papers
Radiology, 2002
PURPOSE: To compare the diagnostic yield of abdominal radiography with that of computed tomography (CT) in adult patients presenting to the emergency department with nontraumatic abdominal pain. MATERIALS AND METHODS: Records of 1,000 consecutive patients presenting to the emergency department with acute abdominal pain from April to June 1998 were retrospectively reviewed. A total of 871 patients underwent abdominal radiography, and 188 underwent abdominal CT. The report interpretations of the abdominal radiographs and CT scans were divided into normal, nonspecific, and abnormal categories. Final discharge diagnoses were compared with the interpretations of the imaging examination results, and sensitivities and specificities of each modality were calculated and compared. RESULTS: Interpretation of abdominal radiographs was nonspecific in 588 (68%) of 871 patients, normal in 200 (23%), and abnormal in 83 (10%). The highest sensitivity of abdominal radiography was 90% for intraabdominal foreign body and 49% for bowel obstruction. Abdominal radiography had 0% sensitivity for appendicitis, pyelonephritis, pancreatitis, and diverticulitis. Sensitivities of abdominal CT were highest for bowel obstruction and urolithiasis at 75% and 68%, respectively.
Role of Plain Abdominal Radiographs in the Evaluation of Patients with Non-Traumatic Abdominal Pain
The Israel Medical Association journal : IMAJ, 2015
Plain abdominal radiographs are still performed as a first imaging examination to evaluate abdominal pain in the emergency department (ED), despite uncertainty regarding their utility. To describe the frequency and outcomes of the use of plain abdominal radiographs in the diagnosis of patients presenting with acute non-traumatic abdominal pain in the ED of a medical center. We retrospectively reviewed the records of patients presenting to the ED with acute abdominal pain during a 6 month period. Further imaging (computed tomography, ultrasonography), when performed, was compared with the abdominal radiography. Of 573 consecutive patients, 300 (52%) underwent abdominal radiography. Findings were normal in 88% (n = 264), non-specific in 7.3% (n = 22), and abnormal in 4.7% (n = 14). For those with normal results, no further imaging was ordered for 43% (114/264). Of the 57% (150/264) who had follow-up imaging, 65% (98/150) showed abnormal findings. In 9 (3%) of the 300 patients, abdomin...
Use of Computerized Tomography in Abdominal Pain
The American Surgeon, 2018
Annually, approximately 70 million computed tomography (CT) scans are performed in emergency department (ED) settings in the United States of America. From 1995 to 2007, there has been a 5.9-fold increase in the use of CTscans nationally. The radiation risks and high costs associated with CTscans underscore the fact that the imaging modality, although necessary, carries a myriad of long-term risks to both patients and providers. For the workup of abdominal pain, most algorithms include the use of CTscan as an early step. To understand better the use of CTscans in our ED, we performed a retrospective review of patients presenting to the ED with abdominal pain. Two main questions were addressed: 1) what were the reasons for scans and how often did the scans reveal pathology related to the presenting symptoms, 2) how often were incidental findings identified. Our results showed that among patients presenting with abdominal pain to the ED, 50 per cent of the scans were normal, about 20 ...
Plain abdominal radiographs and acute abdominal pain
British Journal of Surgery, 1988
The records of all (5080) patients presenting to a district general hospital with acute abdominal pain over a 4-year period were examined. The contribution of abdominal radiographs to the assessment of patients with suspected appendicitis, urinary tract infection, and non-specific abdominal pain was evaluated, these conditions accounting for 48 per cent of patients with abdominal pain and 32 per cent of those with abdominal radiographs. Any positive information from these radiographs was less likely to be helpful than incidental or inconsistent (and hence potentially misleading). Because of this high ‘false positive’ rate it is suggested that if the initial diagnosis is suspected appendicitis, urinary tract infection, or non-specific abdominal pain, there is little value in the routine use of abdominal radiographs.
Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis
Open Access Emergency Medicine, 2022
Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria ® which outlines imaging options based on location of pain.
European Journal of Radiology Open
Identification of clinical predictors of acute and surgical pathologies on abdominal CT in patients with non-traumatic abdominal pain (NTAP). Methods: Retrospective chart review cohort study of adults who had abdominal CT scans for investigation of NTAP in the Emergency Department in a tertiary care center in Lebanon. Multivariate analyses were performed to identify predictors of pathologies on CT scan. Results: This study included 147 patients who had abdominal CT scans for NTAP. Mean age was 39.8 ± 15.1 years and 58.5 % of patients were females. Less than half (44.9 %) had normal scans. Women had significantly higher rates of normal scans compared to males. Right lower quadrant (RLQ) tenderness was associated with significantly higher odds of having acute abnormalities on CT and of having surgical diagnoses, while epigastric tenderness was negatively associated with these two outcomes. Right and left upper quadrants and diffuse abdominal tenderness, and an abnormal neutrophil count were found to be associated with surgical diagnoses on CT. Conclusions: Women are less likely to have acute and surgical pathologies on CT ordered for non traumatic abdominal pain. Epigastric tenderness is negatively associated with abnormal and surgical CT results while RLQ tenderness is associated with an abnormal CT that is likely surgical in nature. These findings should help improve diagnostic accuracy of ordering providers and improve resource utilization.
Routine use of modified CT Enterography in patients with acute abdominal pain
European Journal of Radiology, 2009
To evaluate routine use of CT Enterography (CTE) in patients presenting with non-traumatic acute abdominal pain with respect to patient tolerance, imaging of intestinal detail along with conventional abdominal evaluation. Modified CTE was performed in 165 consecutive patients with acute abdominal pain: ingestion, as tolerated, of 900-1200 ml of 2% barium suspension + 5 ml of Gastrografin over 45 min; 150 ml of iv contrast given in two boluses (50 and 100 ml) 3 min apart (split bolus injection protocol). Axial, coronal and sagittal reformats were reviewed by two radiologists and graded on a 5-point scale (5 best) in regard to GI tract luminal opacification and distension and abdominal organ and vascular enhancement. In 81 patients the cause of abdominal pain was identified (intestinal in 54 and extraintestinal in 27). Oral contrast reached cecum in 76% of the patients and the small bowel was well distended and opacified (medians=4). Mucosa detail was good (median=3) and there was significant (p<0.0001) correlation between bowel opacification and distension for both jejunum and ileum. A combined nephrographic and excretory phase was achieved (medians 4 and 5, respectively), while the great vessels were well opacified, allowing for vascular evaluation (median=5). The rest of the abdominal structures were well visualized. Modified CTE is well tolerated by patients with acute non-traumatic abdominal pain, and can be used routinely as a non-invasive examination informative of bowel, vessel and organ pathology in Emergency Department patients.
Is unenhanced CT sufficient for evaluation of acute abdominal pain?
Clinical Imaging, 2002
Background: To determine whether intravenous contrast improves the ability of radiologists to establish the cause of acute abdominal pain after nondiagnostic or normal unenhanced CT. Methods: Out of 164 consecutive emergency department patients presenting with less than 48 h of nontraumatic, acute abdominal pain, a confident diagnosis for cause of pain was made prospectively in 71/164 (43%) patients on these unenhanced scans by the monitoring radiologist. In the other 93 patients, our study sample, intravenous contrast-enhanced CT was obtained. At a later date, retrospectively, two experienced abdominal CT radiologists independently evaluated unenhanced CT scans alone for potential causes of pain and diagnostic confidence level on a 1 -3 scale. At least 2 weeks later, intravenous enhanced and unenhanced scans were read side-by-side for the same assessment. Results: There was no significant difference in diagnostic confidence levels comparing unenhanced CT alone (2.59) vs. intravenous enhanced and unenhanced CT together (2.64). Chi-square analysis found no significant difference in finding a cause for pain when intravenous contrast was added compared to the initial unenhanced scan alone. Conclusions: Intravenous contrast did not significantly improve the ability of CT to establish a cause of abdominal pain after a negative or nondiagnostic unenhanced CT. D 0899-7071/02/$ -see front matter D 2002 Elsevier Science Inc. All rights reserved. PII: S 0 8 9 9 -7 0 7 1 ( 0 2 ) 0 0 5 3 5 -1
Background: Computed tomography (CT) clarity has significantly improved since it became widely available in the early 1980s, making the utility and benefit of contrast material for image quality of the abdomen and pelvis uncertain, and so far, minimally studied. Objectives: This study sought to assess the efficacy of a noncontrast CT scan of the abdomen and pelvis by evaluating patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain by following them for 7 days and observing for signs and symptoms of clinically significant acute emergent pathology. Methods: We enrolled, and for 7 days followed, a prospective observational convenience sample of patients who received a noncontrast CT scan of the abdomen and pelvis in the ED for acute nontraumatic abdominal pain. The primary outcome, and defined as a failure, was abdominal surgery or death as the result of an intraabdominal process not found on the original noncontrast CT scan, or a subsequent contrasted CT scan with a finding that could explain the original complaint of abdominal pain that was also not seen on the initial noncontrast CT, during the 7-day observation. Results: Seventy-two patients were enrolled in the study. The incidence of failure was 0% (0/72), 46% of patients (33/72) had a negative CT scan, 54% (39/72) had a positive CT scan, 57% (41/72) were admitted, 43% (31/72) discharged, 11% (8/72) had abdominal surgery, and a repeat contrasted CT scan was done on 4% (3/72). Conclusions: With certain inclusion and exclusion criteria, noncontrast CT of the abdomen and pelvis is likely a reliable diagnostic modality for the evaluation of acute nontraumatic abdominal pain in the ED. Ó 2015 Elsevier Inc.