title: Senior surgeons and radiologists should assess emergency patients on presentation: a prospective randomized controlled trial.
abstract: The objective of this study was to determine whether abdominal ultrasound and plain film radiography (evaluated by senior radiologists) substantially enhances senior surgical assessment in reducing surgical admissions. A randomized controlled trial was carried out in a teaching hospital; ninety-five emergency referrals to general surgery (mean age 51 years, 37% males), presenting with intrabdominal disturbances not requiring immediate surgery, were selected for study. The major outcome measure was the number of patients not admitted as in-patients. Thirty per cent of the intervention group and 10% of the controls did not need admission (95% confidence interval on this 29% difference, 12-38%). There were no important differences in the mean waiting time in casualty (26 min vs. 25 min), length of admission (4.1-5.9 days), surgical intervention (seven vs. 11 patients), readmission with similar pathology within 3 months (seven vs. three patients), and mortality as an in-patient or within 3 months of discharge. Abdominal ultrasound and plain film radiography, assessed by senior radiologists, enhances senior surgical assessment in reducing unnecessary surgical admissions.
authors.affiliation: Department of Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Cochrane
authors.forename: A T
authors.initials: AT
authors.lastname: Edwards
authors.forename: D L
authors.initials: DL
authors.lastname: Crosby
authors.forename: C J
authors.initials: CJ
authors.lastname: Roberts
authors.forename: P A
authors.initials: PA
authors.lastname: Lewis
authors.forename: S
authors.initials: S
authors.lastname: McGee
authors.forename: S
authors.initials: S
authors.lastname: Meecham-Jones
authors.forename: A
authors.initials: A
authors.lastname: Jones
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D013502:General Surgery; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D011860:Radiography, Abdominal; D011871:Radiology; D014463:Ultrasonography