ISSN: 1899-0967
Polish Journal of Radiology
Established by prof. Zygmunt Grudziński in 1926 Sun
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1/2022
vol. 87
 
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Gastrointestinal and abdominal radiology
abstract:
Original paper

Are we overusing abdominal computed tomography scans in young patients referred in an emergency for acute abdominal pain?

Sergio Salerno
1
,
Maria Chiara Terranova
1, 2
,
Maria Teresa Anzelmo
1
,
Alessia Vinci
1
,
Federica Vernuccio
1
,
Giorgio Collura
3
,
Maurizio Marrale
3
,
Giuseppe Lo Re
1

1.
Department of Radiology, University Hospital of Palermo, Palermo, Italy
2.
Department of Pediatric Radiology, ARNAS Civico-Di Cristina, Palermo, Italy
3.
University of Palermo, Palermo, Italy
Pol J Radiol 2022; 87: e187-e193
Online publish date: 2022/03/25
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Purpose
The primary objective was to assess the frequency of appropriateness of computed tomography (CT) for acute abdominal pain (AAP) in the emergency department; the secondary aim was to compare the diagnostic accuracy of ultra­sound (US) and CT in the diagnosis of the aetiology of AAP for diseases that can be diagnosed by US; and the third objective was to assess extent to which inappropriate CT examinations for AAP result in ionizing radiation exposure.

Material and methods
In this retrospective single-centre study, we included patients aged between 15 and 46 years referred to the emergency department for AAP in 2016 and submitted to abdominal CT scans, collecting a total of 586 patients. In 152 patients with the more frequent pathologies, we compared the referral reason and current guidelines of the European Society of Radiology (ESR) IGUIDE®. Then we measured and compared the sensitivity of US and CT for the identification of the aetiology of AAP for diseases whose diagnosis can be reached by US. We also recorded the mean computed tomography dose index (CTDIvol), dose length product (DLP) and its standard deviation, and we calculated the effective dose (ED) using CT-Expo® software.

Results
According to IGUIDE and based on the clinical suspicion of CT requests, CT examination was considered crucial in 264 (45.05%) patients. 322 patients had a referral reason for CT scan that could be considered “possibly appropriate” according Iguide criteria (4, 5, 6 scoring). Of these, 135 had an inappropriate CT request according to image findings.

Conclusions
A better clinical framing and a correct interpretation of the reference guidelines could reduce unjustified exposure to ionizing radiation.

keywords:

acute abdominal pain, emergency CT, dose bill, referral




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