title: Is the devil in the detail? The quality and clinical impact of information provided on requests for non-trauma emergency abdominal CT scans.
abstract: BACKGROUND
  The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests.
  
  
  OBJECTIVE
  To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes.
  
  
  METHODS
  We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians' referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis.
  
  
  RESULTS
  Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome.
  
  
  CONCLUSIONS
  Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.
authors.affiliation: Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa pihuhua@gmail.com.
authors.forename: Puleinge
authors.initials: P
authors.lastname: Ihuhua
authors.affiliation: Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Pitcher
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D011873:Radiology Information Systems; D012189:Retrospective Studies; D013019:South Africa; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014218:Triage
keywords: Acute abdomen; clinical details; computed tomography (CT); diagnostic imaging requests; emergency imaging; referral letter