SENIOR SURGEONS AND RADIOLOGISTS SHOULD ASSESS EMERGENCY PATIENTS ON PRESENTATION - A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

The objective of this study was to determine whether abdominal ultraso und and plain film radiography (evaluated by senior radiologists) subs tantially enhances senior surgical assessment in reducing surgical adm issions. A randomized controlled trial was carried out in a teaching h ospital; ninetyfive emergency referrals to general surgery (mean age 5 1 years, 37% males), presenting with intrabdominal disturbances not re quiring immediate surgery, mere selected for study. The major outcome measure was re number of patients not admitted as in-patients. Thirty per cent of the intervention group and 10% of the controls did not nee d admission (95% confidence interval on this 29% difference, 12-38%). There were no important differences in the mean waiting time in casual ty (26 min vs. 25 min), length of admission (4.1-5.9 days), surgical i ntervention (seven vs. 11 patients), readmission with similar patholog y within 3 months (seven vs. three patients), and mortality as an in-p atient or within 3 months of discharge. Abdominal ultrasound and plain him radiography, assessed by senior radiologists, enhances senior sur gical assessment in reducing unnecessary surgical admissions.