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Utility of Repeated Abdominal CT Scans After Prior Negative CT Scans in Patients Presenting to ER with Nontraumatic Abdominal Pain

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Abstract

Purpose

The purpose of this study was to analyze diagnostic yield of repeat computed tomography (CT) after negative initial CT versus yield of initial CT in patients presenting repeatedly to emergency room (ER) for nontraumatic abdominal pain. Medical costs and radiation exposure from repeat CT could be reduced if repeat CT after negative initial CT has a low diagnostic yield.

Methods

Patients included consecutive adults presenting to William Beaumont Hospital, from 2007 to 2010, undergoing abdominal CT for nontraumatic abdominal pain retrospectively identified by medical diagnostic and CT procedural codes. Exclusion criteria were prior abdominal trauma, recent abdominal surgery, and known chronic gastrointestinal disease. The CT was labeled “positive” if findings explained patient’s abdominal pain or was clinically significant. Positivity rate was compared for repeat versus initial CT.

Results

Among 200 consecutive patients undergoing (659) multiple CTs (mean age = 45.7 years, 74 % female), positivity rate for initial CT (22.5 %) was significantly higher than positivity rates for CT#2 (8.4 %, p = 0.002), for CT#3 (4.9 %, p = 0.005), and for CT ≥ #4 (5.9 %, p = 0.006). Generally, CT positivity rate declined with increasing number of prior negative CTs. CT positivity rate was significantly higher in 100 patients undergoing single CT versus 155 patients undergoing repeat CTs (46.5 vs. 6.5 %, p = 0.0001). Positive repeat CT findings included intestinal mural thickening/mass (7), colitis (5), appendicitis (4), and other (14). Among 15 analyzed clinical parameters, two significantly predicted repeat CT positivity, namely, leukocytosis (p = 0.03) and APACHE-II-score >5 (p = 0.01). Repeat CTs constituted 47 % of all CTs.

Conclusions

Repeat abdominal CT after initially negative CT(s) performed for nontraumatic abdominal pain has a low diagnostic yield. Leukocytosis and APACHE-II score might help predict CT scan positivity. Data suggest restricted abdominal CT utilization in ER patients with multiple prior negative CTs. Findings warrant confirmation in prospective studies.

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References

  1. Dunnick NR, Applegate KE, Arenson RL. The inappropriate use of imaging studies: a report of the 2004 Intersociety Conference. J Am Coll Radiol. 2005;2:401–406.

    Article  PubMed  Google Scholar 

  2. Levin DC, Rao VM, Parker L, et al. Recent trends in utilization rates of abdominal imaging: the relative roles of radiologist and nonradiologist physicians. J Am Coll Radiol. 2008;5:744–747.

    Article  PubMed  Google Scholar 

  3. Sturman MF. Medical imaging in acute abdominal pain. Compr Ther. 1991;17:15–21.

    PubMed  CAS  Google Scholar 

  4. Nawar EW, Niska RW, Xu J. National hospital ambulatory medical care survey: 2005 emergency department summary. Advance data from vital and health statistics; no. 388. Hyattsville, MD; National Center for Health Statistics. 2007. Available at: http://www.cdc.gov/nchs/data/ad/ad386.pdf.

  5. Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609–2617.

    Article  PubMed  CAS  Google Scholar 

  6. Modahl L, Digumarthy SR, Rhea JT, et al. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol. 2006;3:860–866.

    Article  PubMed  Google Scholar 

  7. International Classification of Diseases, 9th revision. Diagnostic and procedural codes. http://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD-9.

  8. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829.

    Article  PubMed  CAS  Google Scholar 

  9. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley; 1981.

    Google Scholar 

  10. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol. 2006;13:25–30.

    Article  PubMed  Google Scholar 

  11. Nagurney JT, Brown DF, Chang Y, Sane S, Wang AC, Weiner JB. Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain. J Emerg Med. 2003;25:363–371.

    Article  PubMed  Google Scholar 

  12. Marincek B. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol. 2002;12:2136–2150.

    PubMed  CAS  Google Scholar 

  13. Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol. 2003;13:418–424.

    PubMed  Google Scholar 

  14. Sala E, Watson CJ, Beadsmoore C, et al. A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol. 2007;62:961–969.

    Article  PubMed  CAS  Google Scholar 

  15. Tsushima Y, Yamada S, Aoki J, et al. Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults. Clin Radiol. 2002;57:507–513.

    Article  PubMed  Google Scholar 

  16. Abujudeh HH, Kaewlai R, McMahon PM, et al. Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR Am J Roentgenol. 2011;196:238–243.

    Article  PubMed  Google Scholar 

  17. Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338:141–146.

    Article  PubMed  CAS  Google Scholar 

  18. Scheinfeld MH, Mahadevia S, Stein EG, et al. Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain? Emerg Radiol. 2010;17:353–360.

    Article  PubMed  Google Scholar 

  19. van Randen A, Lameris W, van Es HW, et al. A comparison of the accuracy of the ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011;21:1535–1545.

    Article  PubMed  Google Scholar 

  20. Lameris W, van Randen A, van Es HW, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy of study. BMJ. 2009;338:b2431.

    Article  PubMed  Google Scholar 

  21. Stoker J, van Randen A, Laméris W, et al. Imaging patients with acute abdominal pain. Radiology. 2009;253:31–46.

    Article  PubMed  Google Scholar 

  22. Anonymous. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37:1–332.

    Google Scholar 

  23. Griffey RT, Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol. 2009;192:887–892.

    Article  PubMed  Google Scholar 

  24. Desmond AN, McWilliams S, Maher MM, et al. Radiation exposure from diagnostic imaging among patients with gastrointestinal disorders. Clin Gastroenterol Hepatol. 2012;10:259–265.

    Article  PubMed  Google Scholar 

  25. Craig O, O’Neill S, O’Neill F, et al. Diagnostic accuracy of computed tomography using lower doses of radiation for patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2012;10:886–892.

    Article  PubMed  Google Scholar 

  26. Singh AK, Desai H, Novelline RA. Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol. 2009;16:133–141.

    Article  PubMed  Google Scholar 

  27. Heverhagen JT, Klose KJ. MR imaging for acute lower abdominal and pelvic pain. Radiographics. 2009;29:1781–1796.

    Article  PubMed  Google Scholar 

  28. Pines JM, Hollander JE, Isserman JA, et al. The association between physician risk tolerance and imaging among patients with gastrointestinal disorders. Am J Emerg Med. 2009;27:552–557.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Dr. Ahmad Al-Jaber of the Radiology Department of William Beaumont Hospital for re-reviewing abdominal CTs for this study.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, 3535 West 13 Mile Rd, Royal Oak, MI, 48073, USA

    Borko Nojkov, Michael C. Duffy & Mitchell S. Cappell

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  1. Borko Nojkov
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  2. Michael C. Duffy
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  3. Mitchell S. Cappell
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Correspondence to Mitchell S. Cappell.

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Nojkov, B., Duffy, M.C. & Cappell, M.S. Utility of Repeated Abdominal CT Scans After Prior Negative CT Scans in Patients Presenting to ER with Nontraumatic Abdominal Pain. Dig Dis Sci 58, 1074–1083 (2013). https://doi.org/10.1007/s10620-012-2473-0

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  • DOI: https://doi.org/10.1007/s10620-012-2473-0

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