Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center.
OBJECTIVE
The objective of our study was to prospectively determine how CT affects physicians' diagnostic certainty and management decisions in the setting of patients with nontraumatic abdominal complaints presenting to the emergency department.


METHODS
We included 584 patients presenting with nontraumatic abdominal complaints to the emergency department from November 2006 through February 2008. Emergency department clinicians were prospectively surveyed both before abdominal CT (pre-CT) and after abdominal CT (post-CT) to determine the leading diagnosis, the diagnostic certainty, and the management decisions. Changes were assessed by Fisher's exact test and the log likelihood ratio.


RESULTS
The most common diagnoses were renal colic (119/584, 20.4%) and intestinal obstruction (80/584, 13.7%). CT altered the leading diagnosis in 49% of the patients (284/584, p < 0.00001) and increased mean physician diagnostic certainty from 70.5% (pre-CT) to 92.2% (post-CT) (p < 0.001; log likelihood ratio, 2.48). The management plan was changed by CT in 42% (244/583) (p < 0.0001). Physicians planned to admit 75.3% of the patients (440/584) to the hospital before CT; that plan was changed to hospital discharge with follow-up in 24.1% of patients (106/440) after CT. Surgery was planned for 79 patients before CT, whereas hospital discharge was planned for 25.3% of these patients (20/79) after CT.


CONCLUSIONS
In the management of patients presenting to the emergency department with nontraumatic abdominal complaints, CT changes the leading diagnosis, increases diagnostic certainty, and changes potential patient management decisions.
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Founders 213D, Boston, MA 02114, USA. habujudeh@partners.org
Hani H
HH
Abujudeh
Rathachai
R
Kaewlai
Pamela M
PM
McMahon
William
W
Binder
Robert A
RA
Novelline
G Scott
GS
Gazelle
James H
JH
Thrall
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D019090:Case Management / Q000458:organization & administration; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration*; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015233:Models, Statistical; D000292:Pelvic Inflammatory Disease / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011159:Population Surveillance; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000706:statistics & numerical data*; D056844:Renal Colic / Q000000981:diagnostic imaging; D012308:Risk Management / Q000379:methods*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D035501:Uncertainty; D014481:United States; D055815:Young Adult