title: The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department.
abstract: BACKGROUND
  Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters.
  
  
  METHODS
  We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions.
  
  
  RESULTS
  Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209.
  
  
  CONCLUSIONS
  Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia, USA waqas.shuaib@emory.edu.
authors.forename: Waqas
authors.initials: W
authors.lastname: Shuaib
authors.affiliation: Dow International Medical College, DUHS, Karachi, Pakistan.
authors.forename: Mariyam
authors.initials: M
authors.lastname: Hashmi
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia, USA.
authors.forename: Arvind
authors.initials: A
authors.lastname: Vijayasarathi
authors.affiliation: University of Mississippi Medical Center, Jackson, Mississippi, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Arunkumar
authors.affiliation: Midtown Dental Practice, Atlanta, Georgia, USA.
authors.forename: Sabeen
authors.initials: S
authors.lastname: Tiwana
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Khosa
mesh_terms: D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005145:Face / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D010482:Periapical Abscess / Q000000981:diagnostic imaging / Q000191:economics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*
keywords: Cost-analysis; Facial CT; Radiation; Turnaround time