Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain

OBJECTIVE. The purpose of this study is to document the impact of CT perfor med in the emergency department of patients presenting with nontraumatic ac ute abdominal pain. SUBJECTS AND METHODS. Fifty-seven patients were enrolled in this prospectiv e study. Using a computer order entry system, emergency department physicia ns were required to report their most likely diagnosis, level of certainty, and management plan for their patients before ordering abdominal CT. After CT was performed, each physician was required to provide again his or her diagnosis, level of diagnostic certainty, and treatment plan. The outcome o f each patient was evaluated by either surgery, other imaging studies, or c linical follow-up. RESULTS, After the abdominal CT, physicians' mean level of certainty in the ir diagnoses increased by 1.5 points ton a five-point scale; p < 0.0001). P atient management Was changed in 33 (60.0%) of 55 patients, Planned treatme nt before CT was admission in 42 patients. Actual admissions after CT total ed 32 patients (excluding the two patients in whom preimaging information w as not recorded). Thus, the net effect of abdominal CT scanning was to aver t 10 (23.8%) of 42 hospital admissions. CONCLUSION. CT performed in the emergency department increases the physicia n's level of certainty, reduces hospital admission rates by 23.8%, and lead s to more timely surgical intervention.