Objectives To evaluate the impact of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause on length of hospital stay and accuracy of diagnosis. Design Randomised, prospective controlled trial. Setting Teaching hospital in England. Participants 120 patients admitted with acute abdominal pain for which no immediate surgical intervention or computed tomography was indicated. Intervention 55 participants were prospectively randomised to early computed tomography (within 24 hours of admission) and 65 to standard practice (radiological investigations as indicated). Main outcome measures Length of hospital stay, accuracy of diagnosis, and, owing to a possible effect on inpatient mortality, deaths during the study. Results Early computed tomography reduced the length of hospital stay by 1.1 days (geometric mean 5.3 days (range 1 to 31) v 6.4 days (1 to 60)), but the difference was non-significant (95% confidence interval, 8% shorter stay to 56% longer stay, P=0.17). Early computed tomography missed significantly fewer serious diagnoses. Seven inpatients in the standard practice arm died. Only 50% (59 of 118) of diagnoses on admission were correct at follow up at 6 months, but this improved to 76% (90) of diagnoses after 24 hours. Conclusions Early abdominopelvic computed tomography for acute abdominal pain may reduce mortality and length of hospital stay. It can also identify unforeseen conditions and potentially serious complications.

Results were evaluated in 81 patients with suspected acute aortic dissection who were examined on a fast CT system capable of a 1 s data acquisition time. 17 patients had Type A and nine had Type B dissections. Radiological assessment provided 78 confident reports and expressed some uncertainty about the diagnosis in three patients. Overall sensitivity for aortic dissection was 96.2% and specificity was 96.4%. When 78 confident reports alone were considered, both sensitivity and specificity reached 100%. Reconstruction of data at 100 ms intervals allowed discrimination between artefacts in the ascending aorta and Type A dissections. CT can often be used as the single investigation prior to surgery for acute Type A dissections.

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