Appropriateness of Computed Tomography and Ultrasound for Abdominal Complaints in the Emergency Department.

Autor: Francisco MZ; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil., Altmayer S; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Verma N; Department of Radiology, University of Florida, Gainesville, FL., Watte G; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Brandao MC; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil., Barros MC; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Mohammed TL; Department of Radiology, University of Florida, Gainesville, FL., Hochhegger B; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: brunoho@ufcspa.edu.br.
Jazyk: angličtina
Zdroj: Current problems in diagnostic radiology [Curr Probl Diagn Radiol] 2021 Nov-Dec; Vol. 50 (6), pp. 799-802. Date of Electronic Publication: 2020 Nov 15.
DOI: 10.1067/j.cpradiol.2020.11.004
Abstrakt: Objective: The purpose of this study was to evaluate the appropriateness of ultrasound (US) and computed tomography (CT) examinations ordered in the emergency department (ED) for abdominal complaints.
Materials and Methods: We reviewed 154 CTs and 154 US orders for appropriateness using evidence-based recommendations by the American College of Radiology. The sample was powered to show a prevalence of inappropriate orders of 25% with a margin of error of 7.5%. Findings in the final reports were compared to the initial clinical diagnosis classified in 4 categories: normal, compatible with initial diagnosis, alternative diagnosis, and inconclusive. We also evaluated the frequency in which a second imaging modality was ordered on the same visit.
Results: A total of 135 CT and 143 US examinations had complete clinical information to allow evaluation of order appropriateness. The rate of inappropriate orders was 36.3% for CT and 84.4% for US. The final report of appropriate orders was significantly more likely to demonstrate findings compatible with the initial diagnosis for both CT (76.7% vs 20.4%, P < 0.0001) and US (38.9% vs 14.4%, P = 0.0093). Inappropriately ordered CT scans were more likely to show no abnormalities (46.9 vs 16.3%, P = 0.0001). An additional imaging order with a secondary modality was requested in 20% of the inappropriate US orders, and 8.2% of the inappropriate CT orders.
Conclusion: The prevalence of inappropriate examinations in the ED was 36.3% for CT and 84.4% for US. Appropriately ordered exams were more likely to yield imaging findings compatible with the initial diagnosis for both modalities.
Competing Interests: Conflicts of interest The authors declare no conflict of interest.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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