SP 5.9- Clinical and cost effectiveness of CT scan as first lineinvestigation in diagnosis and treatment of acute abdominal pain – Is it time to change?
Published Date: 01st September 2019
Publication Authors: Altaf K, Muttoni E, Holdsworth J, Patnam V, Rajaganeshan R, MacDonald S
Background
Abdominal x-ray (AXR) is currently used as a first line radiological investigation in assessing acute abdominal pain, often followed by a CT scan, which may delay diagnosis and treatment.We aimed to assess if AXR was needed at all in assessing these patients and its impact on patient outcomes.
Method(s)
This prospective study included consecutive patients that presented to our surgical assessment unit between 1/10/2018 to 5/11/2018. They underwent an AXR first, followed by a CT or a CT directly. Delay between AXR and CT was recorded and impact on definitivemanagement, including length of stay (LOS) assessed. Cost analyses were performed.
Result(s)
100 patients were included (48 male/52 female). Median age was 65 years (IQR 16-87). 63% patients had AXR first, before a CT, whereas, 38% had CT directly. Median time to AXR was 10.5 hrs (24min-23.5hrs) and to CT was 24 hrs (4.5-488). Median time delay between AXR and CT was 19.5 hrs (2.5-489).Median LOS was 6 days (1-47.5). 45% patients experienced a median delay of 24 hours (2-72) in treatment due to delay in obtaining CT. 55% had longer LOS due to delayed definitive treatment. This translated to extra cost of 335 per patient.
Conclusion(s)
AXR as first line imaging investigation delays definitive treatment, prolongs hospital stay and adds no value to management in patients with acute abdominal pain. CT scan improves diagnostic efficacy and definitive management, being cost effective at the same time and should be considered as first line investigation.
Altaf, K; Muttoni, E; Holdsworth, J; Patnam, V; Rajaganeshan, R; MacDonald, S (2019). SP 5.9- Clinical and cost effectiveness of CT scan as first lineinvestigation in diagnosis and treatment of acute abdominal pain – Is it time to change?. British Journal of Surgery. 106 (S5), 26.