Abdominopelvic CT increases diagnostic certainty and guides management decisions: A prospective investigation of 584 patients in a large academic medical center

American Journal of Roentgenology

Volumn 196, Issue 2, 2011, Pages 238-243

  Abujudeh, Hani H ^a   Kaewlai, Rathachai ^a   McMahon, Pamela M ^a   Binder, William ^a   Novelline, Robert A ^a   Gazelle, G Scott ^a   Thrall, James H ^a  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Acute abdomen; CT; Diagnostic imaging; Emergency department; Physician diagnostic certainty; Sensitivity and specificity

Indexed keywords

ABDOMEN; ACUTE ABDOMEN; ADULT; AGED; ARTICLE; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC IMAGING; DIAGNOSTIC VALUE; EMERGENCY PHYSICIAN; EMERGENCY WARD; FISHER EXACT TEST; HOSPITAL ADMISSION; HOSPITAL DISCHARGE; HUMAN; INTESTINE OBSTRUCTION; KIDNEY COLIC; MAJOR CLINICAL STUDY; MEDICAL DECISION MAKING; PATIENT CARE; PATIENT CARE PLANNING; PELVIS; PRACTICE GUIDELINE; PRIORITY JOURNAL;

ACADEMIC MEDICAL CENTERS; ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; AORTIC ANEURYSM, ABDOMINAL; CASE MANAGEMENT; EMERGENCY MEDICAL SERVICES; FEMALE; GASTROINTESTINAL DISEASES; HUMANS; INTESTINAL OBSTRUCTION; LIKELIHOOD FUNCTIONS; MALE; MIDDLE AGED; MODELS, ORGANIZATIONAL; MODELS, STATISTICAL; PELVIC INFLAMMATORY DISEASE; PILOT PROJECTS; POPULATION SURVEILLANCE; PROSPECTIVE STUDIES; QUESTIONNAIRES; RADIOGRAPHY, ABDOMINAL; RENAL COLIC; RISK MANAGEMENT; SENSITIVITY AND SPECIFICITY; TOMOGRAPHY, X-RAY COMPUTED; UNCERTAINTY; UNITED STATES; YOUNG ADULT;

EID: 79251527871     PISSN: 0361803X     EISSN: 15463141     Source Type: Journal    
DOI: 10.2214/AJR.10.4467     Document Type: Article

References (27)

1. The New York Times Website. Rabin RC. With rise in radiation exposure, experts urge caution on tests. www.nytimes.com/2007/06/19/health/19cons.html. Published June 19, 2007. Accessed September 26, 2009
2. AuntMinnie Website. Yee KM. Deficit Reduction Act of 2005 puts radiology through the grinder. www.auntminnie.com/index.asp?sec=ser&sub=def&pag= dis&ItemID=69926. Published March 3, 2006. Accessed September 26, 2009
3. Sala E, Watson CJ, Beadsmoore C, et al. A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol 2007; 62:961-969 (Pubitemid 47317132)
4. Tsushima Y, Yamada S, Aoki J, Motojima T, Endo K. Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults. Clin Radiol 2002; 57:507-513 (Pubitemid 35023880)
5. Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003; 13:418-424 (Pubitemid 36798622)
6. Nagurney JT, Brown DF, Chang Y, Sane S, Wang AC, Weiner JB. Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain. J Emerg Med 2003; 25:363-371
7. Rosen MP, Sands DZ, Longmaid HE 3rd, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR 2000; 174:1391-1396
8. McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med 1992;21:796-801
9. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21:61-72 (Pubitemid 36268468)
10. Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med 1990;19:1383-1386
11. 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. Am J Emerg Med 2004; 22:270-272 (Pubitemid 38918239)
12. Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol 2006; 3:860-866 (Pubitemid 44636381)
13. Centers of Disease Control and Prevention Website. Advance data from vital and health statistics. No. 386. National hospital ambulatory medical care survey: 2005 emergency department summary. www.cdc.gov/nchs/products/ad.htm. Published June 29, 2007. Accessed September 26, 2009
14. Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med 1995; 13:301-303
15. Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emerg Med 1999; 6:947-952
16. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol 2006; 13:25-30
17. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143:29-36
18. Malone AJJ, Wolf CR, Malmed AS, Melliere BF. Diagnosis of acute appendicitis: value of unenhanced CT. AJR 1993; 160:763-766 (Pubitemid 23109971)
19. Taourel PG, Fabre JM, Pradel JA, Seneterre EJ, Megibow AJ, Bruel JM. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR 1995;165:1187-1192
20. Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management - a prospective study of 542 patients. Eur Radiol 2002; 12:1145-1149 (Pubitemid 36940184)
21. Riddell AM, Khalili K. Assessment of acute abdominal pain: utility of a second cross-sectional imaging examination. Radiology 2006; 238:570-577
22. Stromberg C, Johansson G, Adolfsson A. Acute abdominal pain: diagnostic impact of immediate CT scanning. World J Surg 2007; 31:2347-2354; discussion, 2355-2358
23. 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. Am J Emerg Med 2005; 23:259-265
24. Dalrymple NC, Verga M, Anderson KR, et al. The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol 1998; 159:735-740
25. Ha M, MacDonald RD. Impact of CT scan in patients with first episode of suspected nephrolithiasis. J Emerg Med 2004; 27:225-231
26. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998; 338:141-146
27. Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in emergency radiology. Radiology 1999;213:321-339