Effects of eliminating routine use of oral contrast for computed tomography of the abdomen and pelvis: A pilot study

Basile, Joseph V.; Kenny, James F.; Khodorkovsky, Boris; Youssef, Elias; Ardolic, B.; Chacko, Jerel; Hahn, Barry

doi:10.1016/j.clinimag.2018.03.002

Cited by 8 publications

(12 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In conclusion, this study shows that in patients presenting to ED with undifferentiated abdominal pain, eliminating oral contrast in patients with BMI > 25 is associated with a reduction in the time patients wait for scans to be performed without compromising diagnostic quality. Data from this study and similar previous studies 1,3,6 can be used to push for a widespread elimination of oral contrast in ED which would have the effect of reducing length of stay, allowing EDs to offer timely review and intervention for a greater number of patients and allowing for better adherence to government enforced time limits for funding purposes.…”

Section: Discussionmentioning

confidence: 72%

“…Abdominal pain is one of the leading presenting complaints for patients presenting to the ED 1 . Due to its non‐specific nature, abdominal pain typically results in disproportionately longer times to definite disposition 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…However, depending on imaging protocols, radiological studies such as CTAP can add to the ED patient throughput time. In particular, CTAP with oral contrast requires patients to wait for up to 120 min after the ingestion of the contrast agent before being scanned to ensure adequate opacification of the bowel 1 . This adds to length of patient stay for EDs and also comes with the risk of morbidities such as abdominal cramping, diarrhoea and allergic reactions as well as poor palatability of some contrast agents 4 …”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have shown that oral contrast does not affect diagnostic confidence and accuracy of radiologists in the investigation of acute abdominal pain, 2,3,5 especially when there is sufficient intra‐abdominal fat to identify inflammatory changes of the adjacent viscera. Furthermore, many studies have investigated the effect of eliminating oral contrast in the workup of acute abdominal pain which showed improved times to CT completion and ED discharge when oral contrast was phased out 1,3,6 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Elimination of oral contrast leads to faster scans in the workup of abdominal pain in the emergency setting without compromising diagnostic accuracy

et al. 2020

View full text Add to dashboard Cite

Introduction:The aim of this study was to study how the effect of eliminating oral contrast for computed tomography of the abdomen and pelvis (CTAP) in the workup of abdominal pain in the emergency department (ED) would affect the time from patient review to scan and time from review to discharge. Methods: In this retrospective study, we analysed all ED presentations with abdominal pain to our university affiliated tertiary hospital before and after a protocol that eliminated oral contrast-enhanced CTAPs were implemented in September 2018. Two equivalent periods between September and November of 2017 and 2018 were analysed. Patients were excluded if they had a history of anatomy-altering gastrointestinal surgery, history of inflammatory bowel disease, trauma, suspicion of foreign body ingestion or suspected gastrointestinal bleeding. Results: A total of 176 pre-protocol and 197 post-protocol patients were included in the study. We found that the elimination of oral contrast was associated with a decrease in mean time between ED review and scan by 110 min (379 vs. 269 min). We also found that the elimination of oral contrast did not significantly alter the pattern of radiological diagnoses seen between the two study periods, suggesting the absence of oral contrast does not affect diagnostic accuracy. Conclusion: Thus, eliminating the use of oral contrast in the workup of abdominal pain in the ED can lead to increased throughput and more timely patient care.

show abstract

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Elimination of oral contrast leads to faster scans in the workup of abdominal pain in the emergency setting without compromising diagnostic accuracy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In such cases, a causative diagnosis for a patient may not be initially established, and further evaluation with fluoroscopy is required. It is also important to note that oral (PO) contrast is not routinely used on many initial CT protocols, especially in the ED[ 30 ]. The reasons are varied and beyond the scope of this discussion; however, in cases where diagnosis is in doubt (particularly in GI cases), PO contrast for further evaluation will be needed in some form.…”

Section: Category 2: Fluoroscopy As a Complement To Other Modalitiesmentioning

confidence: 99%

Fluoroscopy: An essential diagnostic modality in the age of high-resolution cross-sectional imaging

Shalom

Gong

Auster

2020

WJR

View full text Add to dashboard Cite

The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities, including high-resolution computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness, insufficient training of residents, fewer staff with adequate expertise, and poor reimbursements relative to other modalities. We revisit and build upon the prior literature and history of this decreased utilization. We then seek to prove continued value, through categorized examples and within multiple subspecialties, wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes. This is particularly true for motility and esophageal disorders, where structure and function with real-time evaluation is essential. We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent. The fluoroscopic radiologist also has the unique ability to vary patient positioning, as opposed to traditional CT or MRI, where orthogonal views are employed without positional or temporal changes. We turn attention to the modern era, with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities. Our cases stress the need to maintain expertise in fluoroscopy skill, and underline its continued importance in residency training programs. We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology. We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers, as well as to aid clinicians in the optimal treatment of patients.

show abstract

Acute, Nonspecific, Nontraumatic Abdominal Pain

Silva

Bellolio

2023

Evidence‐Based Emergency Care

View full text Add to dashboard Cite

Effects of eliminating routine use of oral contrast for computed tomography of the abdomen and pelvis: A pilot study

Cited by 8 publications

References 8 publications

Elimination of oral contrast leads to faster scans in the workup of abdominal pain in the emergency setting without compromising diagnostic accuracy

Elimination of oral contrast leads to faster scans in the workup of abdominal pain in the emergency setting without compromising diagnostic accuracy

Fluoroscopy: An essential diagnostic modality in the age of high-resolution cross-sectional imaging

Acute, Nonspecific, Nontraumatic Abdominal Pain

Contact Info

Product

Resources

About