Abdominal pain is one of the most common reasons for emergency department visits. But can computed tomography (CT) scans help physicians make a quick, accurate diagnosis of what is causing the pain? Physicians at Massachusetts General Hospital in Boston who completed pre- and post-CT surveys say the answer is yes.
The surveys tracked diagnostic and treatment information for 584 patients seen in the emergency department from November 2006 to February 2008 for abdominal pain that was not caused by a traumatic injury. Physicians’ responses on the surveys showed that CT scan results changed diagnoses in 49% of the patients and treatment plans in 42%. The number of patients who would have been held for observation decreased by 44%, and planned admissions decreased by nearly 20%.
Little evidence is available to show whether CT scans can improve diagnostic decisions in the emergency department. Some common symptoms, such as headache, have clear diagnostic guidelines for CT use. But that is not the case for abdominal pain.
In the survey, physicians said that using CT scans boosted their confidence in their diagnoses, even when the scan results did not change the diagnosis or treatment plan. “Poor diagnostic certainty can lead to poor decision making,” lead author Hani Abujudeh, MD, MBA, said in a statement. “Increased certainty improves treatment planning and can reduce inappropriate utilization of hospital resources.”
The study, which appears in the February 2011 issue of the American Journal of Roentgenology (Abujudeh H et al. AJR Am J Roentgenol. 2011;196:238-243), did not include a cost analysis. But the study’s senior author said that cost is an important consideration and that CT scans might lower overall costs by reducing the use of other tests and procedures.