CT scanning aids rapid diagnosis, treatment planning for abdominal pain

January 21, 2011

The use of CT scanning to evaluate abdominal pain in emergency departments can help physicians arrive at a diagnosis quickly and decisively. A study conducted at Massachusetts General Hospital (MGH) and appearing in the February issue of the American Journal of Roentgenology also finds that information provided by CT scans changed treatment plans for almost half the patients studied and significantly reduced probable hospital admissions.

"Our report addresses an important question with substantial policy relevance – what is the value of in the emergency department setting?" says Scott Gazelle, MD, MPH, PhD, an MGH radiologist and director of the Institute for Technology Assessment, senior author of the study. "We specifically looked at how the use of CT for patients with abdominal pain affects physicians' thinking about their patients' diagnosis, their confidence in the diagnosis and the treatment plan; and we found that it significantly affected all three."

Gazelle explains that imaging has become a target for efforts to reduce health care costs. "We've strongly believed that the use of CT in the emergency department can improve efficiency in the workup for many conditions, but we haven't had the evidence we would like to back up that assertion. We chose abdominal pain for our study because it's a common presenting symptom that doesn't have the clearly defined diagnostic guidelines available for other common symptoms that can lead to CT, like headache."

Over a 15-month period from November 2006 through February 2008, physicians in the MGH Emergency Department (ED) who ordered CT scans for patients with not associated with a traumatic injury were asked to complete a questionnaire both before the scan was conducted and again after receiving the results. The questionnaire included the physicians' current diagnosis of the probable cause of symptoms, their level of confidence in the diagnosis and their expected treatment recommendations.

Complete sets of questionnaires on the care of 584 patients were available for analysis. The CT scan results changed the diagnosis for 49 percent of patients and the management plan for 42 percent. The number of patients who would have been held for observation – possibly including additional diagnostic procedures – decreased 44 percent, and the number of planned was reduced almost 20 percent. The use of CT scanning significantly increased physicians' confidence in their diagnosis – both when the scan changed and when it did not change the prescan diagnosis – and that improvement was more pronounced in resident physicians than in staff physicians.

"Poor diagnostic certainty can lead to poor decision making," explains lead author Hani Abujudeh, MD, MBA, of MGH Radiology. "Increased certainty improves treatment planning and can reduce inappropriate utilization of hospital resources. Overall, the CT scan is an important tool for providing our patients with appropriate and timely care."

Gazelle adds, "While we didn't include a cost analysis in our study, it is fair to say that our results suggest the CT scan might reduce the use of other tests and procedures and therefore lower overall costs. Another benefit is that CT provides rapid results, which makes the workup process more efficient and can reduce both monetary costs and the time required to move patients through the ED."

Related Stories

Recommended for you

Researchers identify gene variants linked to a high-risk children's cancer

September 25, 2017
Pediatric researchers investigating the childhood cancer neuroblastoma have identified common gene variants that raise the risk of an aggressive form of that disease. The discovery may assist doctors in better diagnosing ...

Prostaglandin E1 inhibits leukemia stem cells

September 25, 2017
Two drugs, already approved for safe use in people, may be able to improve therapy for chronic myeloid leukemia (CML), a blood cancer that affects myeloid cells, according to results from a University of Iowa study in mice.

MRI contrast agent locates and distinguishes aggressive from slow-growing breast cancer

September 25, 2017
A new magnetic resonance imaging (MRI) contrast agent being tested by researchers at Case Western Reserve University not only pinpoints breast cancers at early stages but differentiates between aggressive and slow-growing ...

Cancer vaccines need to target T cells that can persist in the long fight against cancer

September 25, 2017
Cancer vaccines may need to better target T cells that can hold up to the long fight against cancer, scientists report.

Lung cancer treatment could be having negative health effect on hearts

September 25, 2017
Radiotherapy treatment for lung cancer could have a negative effect on the health of your heart new research has found.

Alternative splicing, an important mechanism for cancer

September 22, 2017
Cancer, which is one of the leading causes of death worldwide, arises from the disruption of essential mechanisms of the normal cell life cycle, such as replication control, DNA repair and cell death. Thanks to the advances ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.