Plain abdominal radiography in acute abdominal pain—is it really necessary?

Abstract

The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and attitudes of emergency physicians with regard to ordering AXRs in patients presenting with acute abdominal pain. A retrospective study was undertaken at an ED of a tertiary hospital in Tasmania using clinical notes on patient presenting with acute abdominal pain who underwent an AXR. The study also included a short questionnaire, which assessed emergency physicians' knowledge of current imaging guidelines and clinical practice when ordering an AXR. During the study period, 108 patients satisfied the selection criteria, and the AXR was reported as normal in 76 % (n = 82; p value <0.05), non-specific in 12 % (n = 13; p value <0.05) and abnormal in 12 % (n = 13; p value <0.05) of patients. Of those patients, 25 % (n = 27) of the AXRs did not meet indications listed in the Diagnostic Imaging Pathways published by the Western Australia Department of Health and were found not to benefit patient care. Of the 19 doctors who completed the survey, only 16 % (n = 3) were aware of any clinical guidelines for imaging in this setting. Current guidelines should be followed when ordering imaging for patients with acute abdominal pain to minimise unnecessary patient radiation exposure, avoid delays in diagnosis and definitive patient management, reduce costs and therefore increase efficiency in ED.

Appropriateness of adult plain abdominal radiograph requesting in a regional Emergency Department

“…CT is highly sensitive in the setting of acute abdominal pain . However, lower levels of radiation exposure (10 mSv) and potential savings in cost and time are favourable points when considering AXR use over CT …”

“…Adherence to guidelines for AXR use has been poor in various academic settings . A prospective study in a district hospital in the UK noted that out of 131 plain AXRs performed for acute medical admissions only 16 cases (12%) conformed to the recommended guidelines by the RCR .…”

“…Other studies from tertiary hospitals in the UK and India identified that RCR guidelines for AXR use were followed in around 30% of cases. A study from a tertiary hospital ED in Tasmania found that 76% of AXRs taken were normal, and 25% of those ordered were inconsistent with published guidelines …”

Emergency Medicine Physician Ordering of Abdominal Radiographs for Acute, Non Traumatic, Abdominal Pain

“…A recent study from Australia found 76% of AXR in their patient population to be normal, they reference the Western Australia Department of Health Diagnostic Imaging Pathways as a way to reduce the use of AXR and estimate a 25% reduction in use in their patients if the guidelines were applied [12,13]. Similar or greater reductions would have been achieved in our patient population by eliminating diagnoses where AXR is unlikely to yield any information and by substituting CXR for AXR when perforation is being ruled out.…”

The use of abdominal imaging studies in children visiting emergency department was variable and unsystematic

“…A variety of aetiologies, such as infections, surgical conditions and malignancies, can cause acute abdominal pain in children and the diagnostic performance of the various imaging modalities in these may vary. Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) have gradually, but not completely, replaced abdominal X‐ray as a first‐line modality . A major disadvantage of plain X‐ray and especially CT is exposure to ionising radiation, which has led to increasing use of non‐radiating ultrasound and MRI as primary paediatric imaging modalities .…”