Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients

Pickhardt, Perry J.; Nelson, Leslie W.

doi:10.1007/s00261-019-02064-6

Cited by 8 publications

(2 citation statements)

References 21 publications

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“…An established CT imaging program provides a diagnostic workhorse of consistent, reproducible images that can support growth in the entire hospital system from emergency imaging through advanced oncologic care. CT images are standardized through predetermined protocols, are less operator dependent compared to ultrasound, and can make a wider variety of confident diagnoses than radiography or ultrasound [ 27 – 29 ]. While on-site radiology support is invaluable, many countries have shortages of radiologists with greater concentrations in urban centers [ 8 , 10 ], leading to inconsistent or limited radiologist presence in rural areas.…”

Section: Resultsmentioning

confidence: 99%

CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center

et al. 2023

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Purpose Radiology global health opportunities are expanding as more hospitals in low- and middle-income countries utilize CT. This creates opportunities for global health program building, education, service, and research. This study determines the diagnostic yield and variety of abdominopelvic CT diagnoses for abdominal pain in a US academic medical center (UW) compared to a rural Kenyan teaching hospital (Tenwek). Methods A retrospective, cross-sectional sequential sample of 750 adults from both hospitals who underwent abdominopelvic CT for abdominal pain from February 2019 through July 2020 was obtained. Exclusion criteria were trauma, cancer staging, and recent hospitalization or surgery. Patient age, sex, comparison studies, use of contrast, known cancer diagnosis, and CT diagnoses were compared. Negative exam rate, acute abdomen diagnosis, and new cancer diagnosis were recorded. Statistical analysis was performed using R. Results 750 UW patients met inclusion criteria (mean age 53.3 ± 20 years; 442 women) and 750 Tenwek patients met inclusion criteria (mean age 52.5 ± 18 years; 394 women). 72% of UW patients had comparison imaging compared to 6% of Tenwek patients. 11% (83/750) of UW patients had a known cancer diagnosis compared to 1% (10/750) of Tenwek patients. 39% of UW patients had a negative exam compared to 23% of Tenwek patients ( p < 0.001). 58% of UW patients had an acute abdomen diagnosis compared to 38% of Tenwek patients ( p < 0.001). 10 of the 15 top acute abdomen diagnoses were shared, but in different order of frequency. Diagnoses unique to UW were diverticulitis, constipation, stercoral colitis, and epiploic appendagitis. Diagnoses unique to Tenwek were tuberculosis and hydatidosis. 3% of UW patients received a new cancer diagnosis (7/19 metastatic), compared to 40% of Tenwek patients (153/303 metastatic) ( p < 0.001). Conclusion For adults undergoing CT for abdominal pain, there are differences in the prevalence of abdominal pain diagnoses, new cancer diagnosis, and negative exam rate between the rural Kenyan teaching hospital and the US academic medical center. Graphical Abstract

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Section: Resultsmentioning

confidence: 99%

CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center

et al. 2023

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“…These advances have entrenched CT as the modality of choice for definitive assessment of abdominal oncology staging, acute abdominal trauma, bowel obstruction, non-specific acute abdominal pain and post-operative complications. 6 , 7 , 16 , 17 Similarly, technological CT enhancements could have contributed to preferential use of CT angiography over arterial sonography.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in ultrasound utilisation in the radiology department of a tertiary hospital

2022

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Background: Little is known about the combined impact of increasing ultrasound usage by clinical disciplines outside radiology and technical advances in other specialised radiological modalities on the role of ultrasound in tertiary-level radiology departments.Objectives: The aim of this study was to evaluate temporal trends in ultrasound utilisation in a tertiary-level radiology department.Method: An institutional review board-approved retrospective descriptive study in the radiology department of Tygerberg Hospital (TBH). The nature and number of ultrasound performed in 2013 and 2019 were retrieved from the TBH radiology information system (RIS). These were compared, expressed as a proportion of the overall annual radiology workload and stratified by location (ultrasound suite, interventional suite, mammography suite). Ultrasound suite examinations were analysed by body part and age (0–13 years; 13 years) and interventional suite workload by procedure.Results: The overall radiology workload decreased by 8%, reflecting the interplay between decreased plain radiography (–19%) and general fluoroscopy (–0.3%) and increased computed tomography (27%), magnetic resonance (23%) and fluoroscopically guided procedures (22%).There was a 12% increase in ultrasound utilisation. Ultrasound remained the second most common specialised imaging investigation throughout, after computed tomography. Ultrasound suite services were stable (–1%) representing a balance between decreased abdominal (–22%) and arterial (–16%) scans, and increased musculoskeletal (67%), small part (65%) and neonatal brain scans (41%). There were substantial increases in interventional (90%) and mammography suite (199%) services.Conclusion: Ultrasound remains a key modality in the tertiary-level radiology department, with an evolving pattern of clinical applications.

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Positive oral contrast material for CT evaluation of non-traumatic abdominal pain in the ED: prospective assessment of diagnostic confidence and throughput metrics

et al. 2022

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Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients

Cited by 8 publications

References 21 publications

CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center

CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center

Temporal trends in ultrasound utilisation in the radiology department of a tertiary hospital

Positive oral contrast material for CT evaluation of non-traumatic abdominal pain in the ED: prospective assessment of diagnostic confidence and throughput metrics

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