title: Unexpected changes in clinical diagnosis: early abdomino-pelvic computed tomography compared with clinical evaluation.
abstract: BACKGROUND
  To evaluate the value of early computed tomography (CT) on identifying clinically "unexpected" diagnosis in patients presenting with "non specific" acute abdominal pain.
  
  
  METHODS
  All patients presenting to on-call surgeons with acute abdominal pain were eligible study participants. Patients were randomised to CT within one hour of admission or supine abdominal and erect chest radiography. Ninety-nine patients randomized to CT arm were reviewed for the purpose of this study. The number and severity of unexpected and/or incidental diagnoses detected on the CT were assessed.
  
  
  RESULTS
  In 20 of the 99 patients CT revealed primary or secondary diagnoses, which were unexpected following the initial clinical examination and led to completely different therapeutic options. In 15 of those 20 patients CT revealed clinically unexpected conditions, whereas in two patients severe complications of the clinically suspected diagnosis were detected on CT. Five patients had significant incidental findings in addition to their primary diagnosis on CT. In two of these patient CT also revealed clinically unexpected diagnoses.
  
  
  CONCLUSIONS
  Early CT has the advantage of detecting unexpected clinically significant primary and secondary diagnoses in patients presenting with acute abdominal pain and best guides the surgeon to the appropriate patient management.
authors: Department of Radiology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge CB22QQ, UK. es220@radiol.cam.ac.uk
authors: Evis
authors: E
authors: Sala
authors: Clare
authors: C
authors: Beadsmoore
authors: Daniel
authors: D
authors: Gibbons
authors: Ashley
authors: A
authors: Shaw
authors: Mathew
authors: M
authors: Gaskarth
authors: Thomas
authors: T
authors: Groot-Wassink
authors: Christopher
authors: C
authors: Watson
authors: Adrian K
authors: AK
authors: Dixon
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol