The use of pre-operative computed tomography in the assessment of the acute abdomen

Weir-McCall, JR; Shaw, Ashley; Arya, Abhinav Prakash; Knight, Alexandra L.; Howlett, D.C.

doi:10.1308/003588412x13171221501663

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…[12][13][14] The results are also in keeping with reports of specific acute abdominal diagnoses such as appendicitis with an accuracy of 80.6-99%, [15][16][17] gastrointestinal perforation with an accuracy of 86%, 18 bowel ischaemia with an accuracy of 79.17-81%, 19,20 diverticulitis with an accuracy of 98% 21 and bowel obstruction with an accuracy of 65-97%. [22][23][24][25][26] However, the variable accuracy related to anatomical location of the pathology has not been described.…”

Section: Discussionsupporting

confidence: 77%

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Relative accuracy of emergency CT in adults with non-traumatic abdominal pain

Perry¹,

Foley²,

Witherspoon³

et al. 2016

BJR

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Objective: CT examination prior to emergency laparotomy has become ubiquitous in contemporary clinical practice, but the relative accuracy of CT in this context has not been widely reported. The aim of this study was to determine the accuracy and strength of agreement between the perceived pre-operative CT diagnosis and operative findings. Methods: Data from patients undergoing pre-operative CT prior to emergency laparotomy from January 2013 to June 2014 in a large teaching hospital were analysed. The CT diagnosis was compared with operative findings using the x 2 test and weighted kappa statistic (Kw). Results were further analysed related to the time of day the CT was reported, anatomical location and grade of the reporting radiologist.

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Section: Discussionsupporting

confidence: 77%

“…12 The overall accuracy of the initial CT report by either registrar or consultant was 81%, which improved to 93% following review by a second consultant, although this difference was not significant (p 5 0.15). These findings are therefore consistent, and indeed again, no significant difference was found to be related to radiologist grade.…”

Section: Discussionmentioning

confidence: 84%

Relative accuracy of emergency CT in adults with non-traumatic abdominal pain

Perry¹,

Foley²,

Witherspoon³

et al. 2016

BJR

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“…The diagnostic performance parameters in our study were similar to those quoted by previous studies. [1][2][3] We demonstrate that CT scanning of the acute abdomen improves diagnostic performance. In patients who are acutely unwell, however, CT scanning should not delay commencement of treatment, be it medical or surgical.…”

Section: Discussionmentioning

confidence: 74%

“…In addition, the duration of symptoms and signs of acute abdomen do not affect the sensitivity of CT scanning assessment. 1 Separate studies by Weir-McCall et al 2 and Taourel et al 3 have reported the accuracy of CT scanning in detecting the causes of acute abdomen to be 93% and 95%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Is There a Correlation between Computed Tomography Scanning of the Acute Abdomen and Associated Surgical Outcomes?

Tan¹,

Waxman²

2015

Hong Kong J Radiol

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Objectives: To determine the correlation between computed tomography (CT) scanning in evaluating the acute abdomen and the associated surgical outcome. Methods: This was a retrospective observational study of 362 patients (198 females, 164 males) admitted with an acute abdomen and underwent surgery to the Acute General Surgery and Colorectal Units at Dandenong District Hospital, Australia, between 1 January 2012 and 30 June 2012. Overall, 100 patients (case group) underwent an inpatient preoperative CT scan whereas 262 patients (control group) did not. Surgical outcome was compared between the case and control groups. In the case group, CT diagnosis was compared with the final surgical diagnosis to generate diagnostic performance parameters. Results: CT scanning of the acute abdomen had an accuracy of 88%, sensitivity of 88%, and specificity of 100%. The most common cause of the acute abdomen in both case and control groups was appendicitis. The mean length of hospital stay was 4.0 days in the control group and 9.6 days in the case group. Surgical outcome was worst in the case group for patients aged over 31 years, although rates of reoperation and intensive care unit stay were higher in those aged over 60 years in the control group. Differences in surgical outcome were not statistically significant. Conclusion: CT scanning of patients with an acute abdomen improves diagnostic performance and should be used as an adjunct to clinical evaluation if the benefits outweigh the risks. Surgical outcome in the acute abdomen is not influenced by preoperative CT scanning.

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“…In other centres, particularly overnight, radiology registrars may be responsible for interpreting the scans and for seeking consultant opinion when they feel necessary. Reassuringly, a recent UK study, assessing the diagnostic accuracy of CT in patients who underwent emergency laparotomy having presented with an acute abdomen, found no difference in the diagnostic accuracy of the initial registrar CT report compared to consultant reinterpretation [ 25 ]. Similarly a study of after-hours reporting by senior registrars demonstrated a comparable 92% accuracy of registrar CT reporting with a higher discrepancy rate actually being made within working hours [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Utility and Clinical Impact of After-Hours CT Scans of the Abdomen and Pelvis Investigating Abdominal Pain

Karia

Seager

Rafique

et al. 2017

The Scientific World Journal

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Introduction The aim of this study was to evaluate the diagnostic utility and impact on clinical management of after-hours CT scans investigating abdominal pain in surgical patients. Methods After-hours CT A/P reports investigating the acute surgical abdomen were compared with clinical outcomes and histopathological findings to assess sensitivity and specificity of CT reporting. Comparisons between CT reports and clinical notes were made. CT scans were categorised as having direct effects on clinical management, ruling out a serious pathology, ruling out a nonserious pathology, or having no effect. Discrepancies between information in case-notes and information provided to radiologists were also analysed. Results 79 clinical notes were located. After-hours CT demonstrated 91% sensitivity and 82% reporting specificity using clinical outcomes as the standard. In the 26 patients with histopathological findings, CT reports demonstrated 91% sensitivity. In 79.7% of cases, CT scanning had an impact on management. In 35.4% of cases, an indication for scanning was not documented with variation in clinical information in 8.9% of cases. Discussion This study demonstrates after-hours CT A/P reports result in significant impacts on clinical management of surgical patients with acute abdominal pain. Improvements in providing information when requesting scans are however needed to facilitate accurate reporting.

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The use of pre-operative computed tomography in the assessment of the acute abdomen

Cited by 17 publications

References 21 publications

Relative accuracy of emergency CT in adults with non-traumatic abdominal pain

Relative accuracy of emergency CT in adults with non-traumatic abdominal pain

Is There a Correlation between Computed Tomography Scanning of the Acute Abdomen and Associated Surgical Outcomes?

The Diagnostic Utility and Clinical Impact of After-Hours CT Scans of the Abdomen and Pelvis Investigating Abdominal Pain

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