[Impact of computed tomography on patient's care in nontraumatic acute abdomen: 90 patients].
OBJECTIVE
To determine the contribution of computerized tomography (CT) to the management of nontraumatic acute abdomen, to evaluate interobserver agreement and the contribution of CT to cost control, to look for the predictive factors of CT.


METHODS
and method. Ninety prospectively included patients, admitted for nontraumatic acute abdomen and examined by a surgeon, received CT examination. Diagnosis and treatment 1) envisioned before and 2) defined after CT, and 3) finally retained were compared, and the interobserver agreement was calculated after the second reading. The predictive value of the clinical and biological criteria as well as the radiological criteria characterizing these patients was sought.


RESULTS
CT was contributive in 68.9% of cases, with a reliable diagnosis and treatment strategy, defined after CT examination, for 92.2% and 90%, respectively. Interobserver agreement was 93.3%. CT contributed to reducing costs in 15.5% of patients, for an additional cost estimated at 104-139 euros. The positive predictive factors of the CT contribution were age over 70 years, localized symptoms, fever, and high CRP.


CONCLUSIONS
In agreement with the literature, in our study CT appears to be a choice examination to guide patient care in nontraumatic acute abdomen.
Foinant
M
M
Service de Radiologie B, CHU Clermont-Ferrand, Hôpital G. Montpied, F-63003 Clermont-Ferrand, France.
Lipiecka
E
E
Buc
E
E
Boire
J Y
JY
Schmidt
J
J
Garcier
J M
JM
Pezet
D
D
Boyer
L
L
D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D003363:Cost Control; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000503:physiopathology; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010347:Patient Care Planning; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D014463:Ultrasonography
D002097:C-Reactive Protein