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AJR Am J Roentgenol. 2017 Mar;208(3):570-576. doi: 10.2214/AJR.16.16669. Epub 2017 Jan 11.

Role of CT in the Diagnosis of Nonspecific Abdominal Pain: A Multicenter Analysis.

Author information

1
1 University of Massachusetts Medical School, Worcester, MA.
2
2 Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114.
3
3 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
4
4 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
5
5 Department of Emergency Medicine, Brown University, Providence, RI.
6
6 Department of Radiology, Johns Hopkins University, Baltimore, MD.
7
7 Department of Radiology, University of Washington, Seattle, WA.
8
8 Department of Radiology, Duke University Medical Center, Durham, NC.
9
9 Department of Radiology, Massachusetts General Hospital, Boston, MA.
10
10 Department of Medicine and Division of Hematology/Oncology, University of California, San Francisco, CA.
11
11 Department of Medicine, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.

Abstract

OBJECTIVE:

The objective of our study was to determine whether specific patient and physician factors-known before CT-are associated with a diagnosis of nonspecific abdominal pain (NSAP) after CT in the emergency department (ED).

MATERIALS AND METHODS:

We analyzed data originally collected in a prospective multicenter study. In the parent study, we identified ED patients referred to CT for evaluation of abdominal pain. We surveyed their physicians before and after CT to identify changes in leading diagnoses, diagnostic confidence, and admission decisions. In the current study, we conducted a multiple regression analysis to identify whether the following were associated with a post-CT diagnosis of NSAP: patient age; patient sex; physicians' years of experience; physicians' pre-CT diagnostic confidence; and physicians' pre-CT admission decision if CT had not been available. We analyzed patients with and those without a pre-CT diagnosis of NSAP separately. For the sensitivity analysis, we excluded patients with different physicians before and after CT.

RESULTS:

In total, 544 patients were included: 10% (52/544) with a pre-CT diagnosis of NSAP and 90% (492/544) with a pre-CT diagnosis other than NSAP. The leading diagnoses changed after CT in a large proportion of patients with a pre-CT diagnosis of NSAP (38%, 20/52). In regression analysis, we found that physicians' pre-CT diagnostic confidence was inversely associated with a post-CT diagnosis of NSAP in patients with a pre-CT diagnosis other than NSAP (p = 0.0001). No other associations were significant in both primary and sensitivity analyses.

CONCLUSION:

With the exception of physicians' pre-CT diagnostic confidence, the factors evaluated were not associated with a post-CT diagnosis of NSAP.

KEYWORDS:

CT; abdominal pain; emergency radiology; utilization

PMID:
28075619
DOI:
10.2214/AJR.16.16669
[Indexed for MEDLINE]
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