Diagnosis and disposition are changed when board-certified emergency physicians use CT for non-traumatic abdominal pain.
OBJECTIVE
To determine the effect of abdominal computed tomographic (CT) scan results on diagnosis and disposition of patients with non-traumatic abdominal pain who were evaluated by board-certified emergency physicians (EPs).


METHODS
Prospective, observational study conducted at a safety-net facility with an emergency medicine residency and 65000 annual adult visits. Patients with non-traumatic abdominal pain who underwent an abdominal CT from 3/2011 through 8/2011 were included. Decision to obtain CT was made by the EP. The computer order entry system required the EP to report the most likely diagnosis, and the management and disposition plan. After CT results, the same EP electronically again entered the most likely diagnosis and the planned management and disposition. CTs were interpreted by an attending radiologist. Descriptive statistics and χ(2) tests were used.


RESULTS
Six hundred twenty-nine patients were entered and 547 remained after exclusions; 298 (54%) subjects had a change in diagnosis. In 6 categories, there was a statistically significant change, with non-specific abdominal pain the most common(P < .001); followed by renal colic (P < .001), appendicitis (P < .001), diverticulitis (P < .001), small bowel obstruction (P < .029), and gynecologic process (P < .001). The most common disposition plan was "admit for observation," which was reported in 262 patients and remained in only 122 post CT (47%); 301 (54%) patients whose initial plan was admission were ultimately managed otherwise.


CONCLUSIONS
Abdominal CT use by board certified EPs for nontraumatic abdominal pain changed diagnosis and disposition, with more sent home in lieu of admission. Diagnostic accuracy did not appear to be related to years of clinical experience.
Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: aaron.barksdale@unmc.edu.
Aaron Nathan
AN
Barksdale
Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE.
Jeff Lee
JL
Hackman
Department of Emergency Medicine, Truman Medical Center/UMKC School of Medicine, Kansas City, MO.
Monica
M
Gaddis
Department of Emergency Medicine, Truman Medical Center/UMKC School of Medicine, Kansas City, MO.
Matt Christopher
MC
Gratton
D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D000328:Adult; D002568:Certification; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D064876:Safety-net Providers; D014057:Tomography, X-Ray Computed