Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults.
OBJECTIVE
To determine the impact of computed tomography (CT) on the diagnosis and treatment plan in patients with acute abdominal pain.


METHODS
A prospective study was undertaken in 125 adult patients presenting with acute abdominal pain (74 men and 51 women; 40.2 +/- 19.3 years; range, 18-92). Changes in diagnosis, gain in percentage diagnostic certainty and changes of treatment plan of the surgeons in the emergency department before and after CT were evaluated. Pre- and post-CT diagnoses were compared with the final diagnoses.


RESULTS
CT findings changed the initial diagnosis in 40 (32.0%) patients. The diagnostic certainty was 58.3 +/- 22.9% before CT, and its gain after CT was 21.9 +/- 18.5 points (P < 0.0001). Post-CT diagnoses were consistent with the final diagnosis in 116 patients (92.8%), while pre-CT diagnoses were correct in 89 patients (71.2%; P < 0.0001). Initial treatment plans were changed in 31 (24.8%) patients after CT. In 57 (45.6%) patients, CT information changed diagnoses and/or treatment plans. No significant differences were observed in the diagnosis, diagnostic certainty and treatment plan among four surgeons.


CONCLUSIONS
Contrast-enhanced CT frequently changed the clinical diagnoses with increased diagnostic certainty and the initial treatment plans.
Tsushima
Yoshito
Y
Department of Radiology, Motojima General Hospital, Gunma, Japan. yoshito@xa2.so-net.ne.jp
Yamada
Shuji
S
Aoki
Jun
J
Motojima
Teiji
T
Endo
Keigo
K
D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000000981:diagnostic imaging; D003287:Contrast Media; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media