Routine abdominal X-rays in the emergency department: A thing of the past?

Martín, J.M.; Gracia, M. Martí De; Torres, Cristina Rodríguez; Martínez, D. Marquina; Herranz, P.

doi:10.1016/j.rxeng.2015.08.001

Cited by 2 publications

(9 citation statements)

References 48 publications

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“…Our findings confirm the relatively low diagnostic yield of plain abdominal radiographs, and a high proportion of patients with further imaging being requested, the majority of which were CT scans. This is consistent with previous work suggesting a diagnostic yield of 10–15% for AXR . CT is highly sensitive in the setting of acute abdominal pain .…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with previous work suggesting a diagnostic yield of 10–15% for AXR . 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 …”

Section: Discussionsupporting

confidence: 91%

“…Abdominal pain is a common presenting complaint in the Emergency Department (ED), comprising of up to 8% of total patient visits . Various imaging modalities are used for diagnostic work up including plain AXRs, ultrasound (USG) and CT scans …”

Section: Introductionmentioning

confidence: 99%

“…Problems identified with this modality include moderate sensitivity, low specificity for many intra‐abdominal conditions and a relatively large radiation dose. The dose of one AXR for an individual examination (0.7–1.3 mSv) is 40 times that of a chest X‐ray …”

Section: Introductionmentioning

confidence: 99%

“…Inappropriate utilization of AXRs also incurs additional direct and indirect costs such as technician and radiologist time, delays in obtaining needed investigations, and pregnancy tests for female patients . Such hindrances have led to the development of clinical guidelines such as Diagnostic Imaging Pathways published by the Western Australia Department of Health .…”

Section: Introductionmentioning

confidence: 99%

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

Fernandez¹,

Craig

2019

J Med Imag Rad Onc

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Introduction: Although commonly ordered, abdominal x-rays are thought to be overused and unhelpful in many emergency department patients. Our objectives were to evaluate the appropriateness of plain abdominal X-ray (AXR) requests in adult patients presenting to a Victorian regional emergency department (ED). Methods: A retrospective chart review was performed of all adult patients with a plain AXR requested by ED medical staff members in a regional healthcare centre in Victoria, Australia in 2016. Patient demographics, ED disposition and any further imaging results were extracted from the medical record. Indications for X-ray and clinician seniority were determined from the radiology request slips signed by the treating emergency doctor. Appropriateness of imaging was determined by comparing the indication for abdominal radiograph to local evidence-based guidelines. Results: One hundred and nine episodes of plain AXR requests met the inclusion criteria. Of these, 40 were considered inappropriate according to clinical guidelines. Overall, 36% (39/109) had normal or non-specific findings and 42% (46/109) demonstrated faecal loading, while 22% (24/109) identified pathology. Thirty-three patients had further imaging, mostly with computed tomography (CT). Junior staff members were responsible for most of the AXR requests. Conclusion: In our regional hospital ED, over one third of AXRs requested for adult patients were inappropriate according to clinical guidelines. AXRs have a low diagnostic yield and frequently do not reduce the need for further imaging. The use of a clinical practice guideline and education of junior medical staff may increase the appropriate use of plain AXRs in the regional ED setting.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Fernandez¹,

Craig

2019

J Med Imag Rad Onc

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Appropriate abdominal imaging for the emergency department patient

Knott¹

2021

Proc NSIS

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Abdominal x-ray series (AXR) and abdominal CT scans (ACT) are commonly performed to aid in the diagnosis for patients who present to the emergency room with abdominal pain. Patients commonly receive both an AXR and ACT, due to a lack of knowledge regarding imaging appropriateness among healthcare professionals who order these exams. A primary simple retrospective data-analysis was performed to understand the prevalence of how often both exams were ordered in three Nova Scotia emergency departments. A literature review was also conducted to compare the diagnostic accuracy of each diagnostic imaging modality. Several articles showed that patients who have an AXR also have an ACT that demonstrates an abnormal finding. Emergency department physicians are not reassured when abdominal x-rays are negative and do not show abnormal findings, and as a result, a CT scan is also performed. Radiation dose must be considered when ordering multiple diagnostic imaging exams. A low-dose CT (LDCT) can be used to reduce the radiation exposure to the patient, while maintaining high diagnostic quality images. Image quality can be enhanced at a reduced radiation dose by using an image reconstruction technique such as adaptive statistical iterative reconstruction (ASIR). Understanding the most appropriate abdominal imaging modality for emergency department patients allows for fewer examinations being ordered and a reduction of radiation dose to the patient. When the most appropriate imaging is performed, a definitive diagnosis can be made and the best treatment can be provided to patients. This information can help to create an imaging appropriateness protocol for emergency departments.Additional research can help determine the cost differences between the two exams and the influence a protocol change could have on the emergency and diagnostic imaging departments.Keywords: AXR – Abdominal x-ray series, ACT – Abdominal computed tomography scan, CT – Computed tomography, SDCT – Standard-dose CT, LDCT – Low-dose CT, ASIR – Adaptative statistical iterative reconstruction FBP – Filtered back projection, CTDIvol – Volume computed tomography dose index

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Routine abdominal X-rays in the emergency department: A thing of the past?

Cited by 2 publications

References 48 publications

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

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

Appropriate abdominal imaging for the emergency department patient

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