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Original Research

Open Access

Emergency department chest and abdominal computed tomography: impact on patients’ management

  • MATTEO BRAMBATI1
  • FIORANGELA MARLETTA2
  • ROBERTO LA ROCCA3
  • STEFANO PAGLIA1

1Unità Sanitaria Complessa di Pronto Soccorso, Azienda Ospedaliera della provincia di Lodi, Lodi, Italy

2Unità sanitaria semplice di Pronto Soccorso/Dipartimento Emergenza e Accettazione, IRCCS Policlinico San Donato, San Donato Milanese, Italy

DOI: 10.22514/SV111.052016.8 Vol.11,Issue 1,May 2016 pp.121-131

Published: 02 May 2016

*Corresponding Author(s): MATTEO BRAMBATI E-mail: brambati@hotmail.it

Abstract

Objective. The introduction of computed tomography (CT) has had a very significant impact on patient evaluation and management decisions in the Emergency Department (ED). One of the few published studies demonstrated a positive CT yield in 67% of patients admitted to hospital. The same study demonstrated that in 25% of cases, the CT examination was able to identify a pathological process unidentified by the ED team. Only one study has focused on the evaluation of the variation in patient management that each CT examination is able to achieve. The purpose of our study is to document the impact that CT has on patient diagnosis and management in the ED, employing a large patient series.

Materials and methods. The diagnostic and therapeutic impact of CT was evaluated in a consecutive series of 300 patients who were referred to the radiology department for a chest or abdominal CT examination as requested by the emergency physician.

Results. The net impact of performing a CT was a change in planned treatment in 202 cases out of 300 (67%) and proceding with the planned treatment in the remaining 98 cases (33%). The only intention to demand a CT examination was significantly bound (p=0.015, confidence interval 0.16 and 0.38) to a change in the planned treatment before CT (as it is established with Mc Nemar test).

Discussion. Our study showed that more than 67% of CT reports were able to change the course of treatment planned before CT execution and that in 56% of these cases, the execution of a CT examination was able to generate a major variation in treatment plan.

Keywords

emergency department, computed tomography, chest, abdomen, clinical impact

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MATTEO BRAMBATI,FIORANGELA MARLETTA,ROBERTO LA ROCCA,STEFANO PAGLIA. Emergency department chest and abdominal computed tomography: impact on patients’ management. Signa Vitae. 2016. 11(1);121-131.

References

1. Sosna J, Slasky S, Bar-Ziv J. Computed tomography in the emergency department. Am J Emerg Med 1997 May;15(3): 244-7.

2. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol 2006 Oct;13(1): 25-30.

3. Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol 2006 Nov;3(11):860-6.

4. Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003 Feb;13(2):418-24.

5. ACR Appropriateness Criteria overview. Reston, VA: American College of Radiology; 2010.

6. Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency Department Computed Tomography Utilization in the United States and Canada. Ann Emerg Med 2013 Nov;62(5):486-94.

7. Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med 1995 May;13(3):301-3.

8. Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol 1997 Jan;168(1):173-8.

9. Weishaupt D, Grozaj AM, Willmann JK, Roos JE, Hilfiker PR, Marincek

B. Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol 2002 Jun;12(6):1295-311. Epub 2002 Apr 20.

10. Saini S, Sharma R, Levine LA, Barmson RT, Jordan PF, Thrall JH. Technical cost of CT examinations. Radiology 2001 Jan;218(1):172-5. Figure 1. Evaluation of clinical impact.

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