Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach
Introduction: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. Objective: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients’ therapeutic approach. Methods: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8–12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. Results: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients’ mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. Conclusion: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.
2. Sala E, Watson C, Beadsmoore C, Groot-Wassink T, Fanshawe T, Smith J, et al. A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol. 2007;62(10):961-9.
3. Rosen MP, Sands DZ, Longmaid III HE, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol. 2000;174(5):1391-6.
4. Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13(3):301-3.
5. Siewert B, Raptopoulos V, Mueller M, Rosen M, Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol. 1997;168(1):173-8.
6. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol. 2006;13(1):25-30.
7. Sosna J, Slasky BS, Bar-Ziv J. Computed tomography in the emergency department. Am J Emerg Med. 1997;15(3):244-7.
8. Weishaupt D, Grozaj AM, Willmann JK, Roos JE, Hilfiker PR, Marincek B. Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol. 2002;12(6):1295-311.
9. Howlett D, Drinkwater K, Frost C, Higginson A, Ball C, Maskell G. Re: The accuracy of emergency abdominal CT in adult patients who present with non-traumatic abdominal pain: results of a UK national audit. A reply. Clin Radiol. 2017;72(10):897.
10. Weir-McCall J, Shaw A, Arya A, Knight A, Howlett D. The use of pre-operative computed tomography in the assessment of the acute abdomen. Ann R Coll Surg Engl. 2012;94(2):102-7.
11. Perry H, Foley KG, Witherspoon J, Powell–Chandler A, Abdelrahman T, Roberts A, et al. Relative accuracy of emergency CT in adults with non-traumatic abdominal pain. Br J Radiol. 2016;89(1059):20150416.
12. Lauritzen PM, Andersen JG, Stokke MV, Tennstrand AL, Aamodt R, Heggelund T, et al. Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports. BMJ Qual Saf. 2016;25(8):595-603.