The Appropriate Use of Conventional Abdominal Radiographs and Its Usefulness in Non-Traumatic Acute Abdomen Patients
Keywords:Abdominal radiograph, Acute abdominal pain, Appropriateness criteria, Imaging
Objective: Conventional abdominal radiographs (CAR) are often ordered in patients presented with acute abdominal pain. We investigated the appropriate use of CAR and its usefulness in the Emergency Department (ED).
Methods: Adult patients who had CAR ordered from ED between 1st September and 31st October 2018 were retrospectively reviewed. Patients' demographics, indications for CAR, CAR results, further imaging, and their results, and final diagnoses were assessed. The appropriate or inappropriate use of CAR was stratified. A comparison between the appropriate group and inappropriate group was made.
Results: There were 154 CAR studies, M:F = 57:97, mean age 48.3 years (ranged 15 - 88 years). 33.8% of CAR was considered an appropriate use. Of the 154 examinations, 17 (11%), 73 (47%), and 64 (42%) were reported as positive, negative, and non-diagnostic results by CAR respectively. A comparison between appropriate and inappropriate groups, number of cases, CAR negative results, CAR non-diagnostic result, and negative further imaging results were significantly different. There was no statistical difference in the number of further imaging between both groups. The common findings of positive results that had no further imaging were bowel obstruction (n = 6), followed by bowel perforation (n = 3). 12 out of 73 (16.4%) negative CAR results, and 11 out of 64 (17%) of non-diagnostic results had positive findings from further imaging.
Conclusion: The appropriate use of CAR in non-traumatic acute abdomen patient in our institution is only 33.8%. More precise imaging is required to make a decision whether appropriate indication or not. Strict to the protocols, staff education and internal audit should be performed in the hospital.