Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management.
OBJECTIVE
To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms.


METHODS
Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up.


RESULTS
Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1x10-6) and management (88.5% to 95.8%, p=2.6x10-6) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement.


CONCLUSIONS
Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice.


CONCLUSIONS
• Systematic unenhanced CT improves significantly diagnosis accuracy compared to current practice. • Systematic unenhanced CT optimizes appropriate hospitalization by increasing the number of discharged patients. • Systematic unenhanced CT allows detection of about one-third of acute unsuspected abdominal conditions. • It should allow boosting emergency department management decision-making confidence in old patients.
Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier Cedex 5, France. i-millet@chu-montpellier.fr.
Ingrid
I
Millet
Department of Emergency Medicine, CHU Lapeyronie, Montpellier, France.
Mustapha
M
Sebbane
Department of Medical Information and Statistics, UMR 729 MISTEA, CHU Montpellier, France.
Nicolas
N
Molinari
Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier Cedex 5, France.
Emma
E
Pages-Bouic
Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier Cedex 5, France.
Fernanda
F
Curros-Doyon
Department of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France.
Bruno
B
Riou
Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier Cedex 5, France.
Patrice
P
Taourel
D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging; D001660:Biliary Tract Diseases / Q000150:complications / Q000000981:diagnostic imaging; D000066491:Clinical Decision-Making; D003092:Colitis / Q000150:complications / Q000000981:diagnostic imaging; D003287:Contrast Media; D004066:Digestive System Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D004238:Diverticulitis / Q000150:complications / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital; D005244:Fecal Impaction / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D007418:Intestinal Pseudo-Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging; D010351:Patient Discharge; D010437:Peptic Ulcer / Q000150:complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011704:Pyelonephritis / Q000150:complications / Q000000981:diagnostic imaging; D056844:Renal Colic / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media
Abdominal pain; CT; Diagnostic imaging; Elderly; Emergency medicine