Advertisement

Emergency Radiology

, Volume 25, Issue 4, pp 393–398 | Cite as

Clinical impact of computed tomography in the emergency department in nontraumatic chest and abdominal conditions

  • Lorenzo Carlo Pescatori
  • Matteo Brambati
  • Carmelo Messina
  • Giovanni Mauri
  • Giovanni Di Leo
  • Enzo Silvestri
  • Francesco Sardanelli
  • Luca Maria Sconfienza
Original Article

Abstract

Aim

To evaluate the clinical impact of CT scan in modifying the clinical management in patients referred to the emergency department.

Methods

We prospectively evaluated 300 patients (177 males, 63 ± 18 years old) admitted in the emergency department (ED) of a single institution, who underwent a CT examination for thoracic and/or abdominal complains. Demographic and clinical data were collected. Hypothesized outcome prior to CT scan and final management (i.e., discharge, short observation in the ED, hospitalization, and department of admission) were compared.

Results

After CT examination, a major variation in diagnosis occurred in 37% of cases and clinical management changed in 43%, occurring in 51% of patients who underwent abdominal CT, in 40% of chest CT, and in 29% of chest/abdominal CT (P = 0.015). Department of hospitalization changed in 26% of cases (P < 0.001). Clinical impact of CT scan was significantly associated (P = 0.001) with the color code at admission. In particular, the more severe was the clinical condition, the lower was the variation of management after CT examination.

Conclusions

This work confirms the crucial role of CT examination in the management of nontraumatic patients admitted to the ED, both in terms of better clarifying the diagnosis and in influencing the clinical management.

Keywords

Computed tomography Emergency department Clinical impact Outcome 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived by the relevant Ethics Committee.

References

  1. 1.
    Sosna J, Slasky BS, Bar-Ziv J (1997) Computed tomography in the emergency department. Am J Emerg Med 15:244–247CrossRefPubMedGoogle Scholar
  2. 2.
    Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13:25–30.  https://doi.org/10.1007/s10140-006-0493-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI (2006) Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol 3:860–866.  https://doi.org/10.1016/j.jacr.2006.05.011 CrossRefPubMedGoogle Scholar
  4. 4.
    Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424.  https://doi.org/10.1007/s00330-002-1715-5 PubMedGoogle Scholar
  5. 5.
    Abujudeh H, Kaewlai R, Shah B, Thrall J (2011) Characteristics of falls in a large academic radiology department: occurrence, associated factors, outcomes, and quality improvement strategies. Am J Roentgenol 197:154–159.  https://doi.org/10.2214/AJR.10.4994 CrossRefGoogle Scholar
  6. 6.
    Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Avery LL, Herring MS, Tramontano AC, Dowling EC, Abujudeh HH, Eisenberg JD, Halpern EF, Donelan K, Gazelle GS (2016) CT in the emergency department: a real-time study of changes in physician decision making. Radiology 278:812–821.  https://doi.org/10.1148/radiol.2015150473 CrossRefPubMedGoogle Scholar
  7. 7.
    Eisenberg JD, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Tramontano AC, Herring MS, Dowling EC, Halpern EF, Donelan K, Gazelle GS, Pandharipande PV (2017) Role of CT in the diagnosis of nonspecific abdominal pain: a multicenter analysis. AJR Am J Roentgenol 208:570–576.  https://doi.org/10.2214/AJR.16.16669 CrossRefPubMedGoogle Scholar
  8. 8.
    Gezer NS, Balcı P, Tuna KÇ, Akın IB, Barış MM, Oray NÇ (2017) Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies. Am J Emerg Med 35:623–627.  https://doi.org/10.1016/j.ajem.2016.12.058 CrossRefPubMedGoogle Scholar
  9. 9.
    Millet I, Sebbane M, Molinari N, Pages-Bouic E, Curros-Doyon F, Riou B, Taourel P (2017) Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol 27:868–877.  https://doi.org/10.1007/s00330-016-4425-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Broder JS, Hamedani AG, Liu SW, Emerman CL (2013) Emergency department contrast practices for abdominal/pelvic computed tomography-a national survey and comparison with the american college of radiology appropriateness criteria(®). J Emerg Med 44:423–433.  https://doi.org/10.1016/j.jemermed.2012.08.027 CrossRefPubMedGoogle Scholar
  11. 11.
    Gans SL, Stoker J, Boermeester MA, Boermeester MA (2012) Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med 5:525–533.  https://doi.org/10.2147/IJGM.S17410 PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hastings RS, Powers RD (2011) Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med 29:711–716.  https://doi.org/10.1016/j.ajem.2010.01.045 CrossRefPubMedGoogle Scholar
  13. 13.
    Hasani SA, Fathi M, Daadpey M, Zare MA, Tavakoli N, Abbasi S (2015) Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain: a prospective study. Clin Imaging 39:476–479.  https://doi.org/10.1016/j.clinimag.2015.01.011 CrossRefPubMedGoogle Scholar
  14. 14.
    Gungor F, Kilic T, Akyol KC, Ayaz G, Cakir UC, Akcimen M, Eken C (2017) Diagnostic value and effect of bedside ultrasound in acute appendicitis in the emergency department. Acad Emerg Med 24:578–586.  https://doi.org/10.1111/acem.13169 CrossRefPubMedGoogle Scholar
  15. 15.
    Abujudeh HH, Kaewlai R, McMahon PM et al (2011) Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. Am J Roentgenol 196:238–243.  https://doi.org/10.2214/AJR.10.4467 CrossRefGoogle Scholar
  16. 16.
    Sconfienza LM, Mauri G, Muzzupappa C, Poloni A, Bandirali M, Esseridou A, Tritella S, Secchi F, di Leo G, Sardanelli F (2015) Relevant incidental findings at abdominal multi-detector contrast-enhanced computed tomography: a collateral screening? World J Radiol 7:350–356.  https://doi.org/10.4329/wjr.v7.i10.350 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Schiff GD (2011) System dynamics and dysfunctionalities: levers for overcoming emergency department overcrowding. Acad Emerg Med 18:1255–1261.  https://doi.org/10.1111/j.1553-2712.2011.01225.x CrossRefPubMedGoogle Scholar
  18. 18.
    Dugas A, Therasse E, Kauffmann C, Tang A, Elkouri S, Nozza A, Giroux MF, Oliva VL, Soulez G (2012) Reproducibility of abdominal aortic aneurysm diameter measurement and growth evaluation on axial and multiplanar computed tomography reformations. Cardiovasc Intervent Radiol 35:779–787.  https://doi.org/10.1007/s00270-011-0259-y CrossRefPubMedGoogle Scholar
  19. 19.
    Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F (2005) Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. Eur Radiol 15:2057–2063.  https://doi.org/10.1007/s00330-005-2844-4 CrossRefPubMedGoogle Scholar
  20. 20.
    Memon W, Khattak YJ, Alam T, Sconfienza LM, Awais M, Anwar SSM (2014) MDCT of small bowel obstruction: how reliable are oblique reformatted images in localizing point of transition? Gastroenterol Res Pract 2014:815802–815807.  https://doi.org/10.1155/2014/815802 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2018

Authors and Affiliations

  • Lorenzo Carlo Pescatori
    • 1
  • Matteo Brambati
    • 2
  • Carmelo Messina
    • 3
  • Giovanni Mauri
    • 4
  • Giovanni Di Leo
    • 5
  • Enzo Silvestri
    • 6
  • Francesco Sardanelli
    • 5
    • 7
  • Luca Maria Sconfienza
    • 3
    • 7
  1. 1.Scuola di Specializzazione in RadiodiagnosticaUniversità degli Studi di MilanoMilanItaly
  2. 2.Dipartimento di Biotecnologie e Scienze della VitaUniversità degli Studi dell’InsubriaVareseItaly
  3. 3.Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia InterventisticaIRCCS Istituto Ortopedico GaleazziMilanItaly
  4. 4.Dipartimento di Radiologia InterventisticaIstituto Europeo di OncologiaMilanItaly
  5. 5.Unità di RadiologiaIRCCS Policlinico San DonatoMilanItaly
  6. 6.Servizio di RadiologiaOspedale Evangelico InternazionaleGenovaItaly
  7. 7.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly

Personalised recommendations