title: Emergency department contrast practices for abdominal/pelvic computed tomography-a national survey and comparison with the american college of radiology appropriateness criteria(®).
abstract: BACKGROUND
  Controversy exists regarding the need for contrast agents for emergency abdominal computed tomography (CT).
  
  
  OBJECTIVE
  We surveyed United States (US) academic Emergency Departments (EDs) to document national practice. We hypothesized variable contrast use for abdominal/pelvic CT, including variance from the American College of Radiology's (ACR) Appropriateness Criteria(®), an evidence-based guideline.
  
  
  METHODS
  A survey was sent to physician leaders of US academic EDs, defined as primary site of an Emergency Medicine residency program. Respondents were asked about their institutions' use of oral, intravenous (i.v.), and rectal contrast for various abdominal/pelvic CT indications. Responses were compared with the approach given the highest appropriateness rating by the American College of Radiology.
  
  
  RESULTS
  One hundred and six of 152 (70%) surveys were completed. Intravenous contrast was the most frequently cited contrast. At least 90% of respondents reported using i.v. contrast in 12 of 18 indications. Oral contrast use was more variable. In no indication did ≥90% of respondents indicate use of oral contrast, and in only two indications did ≥90% avoid its use. Rectal contrast was rarely used. The most common indications for which no contrast agent was used were suspected renal colic (79%), viscus perforation (19%), penetrating abdominal trauma (18%), and blunt abdominal trauma (15%).
  
  
  CONCLUSIONS
  Contrast practices for abdominal/pelvic CT vary nationally, according to a survey of US academic EDs. For multiple indications, the contrast practices of a substantial number of respondents deviated from those recommendations given the highest clinical appropriateness rating by the American College of Radiology.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Broder
authors.forename: Azita G
authors.initials: AG
authors.lastname: Hamedani
authors.forename: Shan W
authors.initials: SW
authors.lastname: Liu
authors.forename: Charles L
authors.initials: CL
authors.lastname: Emerman
mesh_terms: D000046:Academic Medical Centers; D000284:Administration, Oral; D000285:Administration, Rectal; D003287:Contrast Media / Q000008:administration & dosage*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D010388:Pelvis / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011860:Radiography, Abdominal; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D003287:Contrast Media