The role of abdominal radiography in the evaluation of the nontrauma emergency patient.
OBJECTIVE
To characterize the utility of abdominal radiography for nontrauma emergency patients in a single-institution setting.


METHODS
Following approval from the Director of Professional Services, a retrospective review of radiography and of patient records was conducted for patients who presented to a nontrauma emergency department over a period of 6 months and who were imaged by using abdominal radiography. Only the first radiograph per patient was used for analysis. The interpretations were sorted as normal, nonspecific, or abnormal. The patients' medical records were reviewed to determine whether further imaging was performed (computed tomography, ultrasonography, or upper gastrointestinal imaging) and results were compared with abdominal radiography. Chart reviews were conducted to identify patients in whom abdominal radiography alone influenced treatment.


RESULTS
In 874 patients, interpretation of abdominal radiography was normal in 34% (n = 300), nonspecific in 46% (n = 406), and abnormal in 19% (n = 168). Further imaging was performed for 50% (436) of all patients. Of 300 patients whose abdominal radiography results were normal, 42% (n = 125) had follow-up imaging; 72% (n = 90) of these showed abnormal, 78% (165 of 212) showed nonspecific, and 87% (86 of 99) showed abnormal findings. Of 438 patients who did not undergo follow-up imaging, 75% (n = 327) were discharged. For all indications other than catheter placement, abdominal radiography helped confirm the suspected diagnosis in 2%-8% of cases. In 37 (4%) of 874 patients, abdominal radiography was possibly helpful in changing patient treatment without a follow-up study.


CONCLUSIONS
Abdominal radiography is often requested; however, its results contribute to patient treatment in a small percentage of cases. With the exception of catheter placement, if a patient requires investigation beyond clinical history, physical examination, and lab results, the emergency physician should be encouraged to request more definitive imaging.
Kellow
Zina S
ZS
Department of Radiology, Royal Victoria Hospital, McGill University, 687 Pine Ave W, Montreal, QC, Canada H3A 1A1. zina.kellow@mail.mcgill.ca
MacInnes
Meaghan
M
Kurzencwyg
David
D
Rawal
Sapna
S
Jaffer
Rehana
R
Kovacina
Bojan
B
Stein
Lawrence A
LA
D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D015994:Incidence; D038622:Internationality; D011860:Radiography, Abdominal / Q000706:statistics & numerical data*; D014481:United States; D014947:Wounds and Injuries / Q000000981:diagnostic imaging