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

Autor: Triche BL; Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA. MLubner@uwhealth.org., Annamalai A; Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA., Pooler BD; Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA., Glazer JM; Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA., Zadra JD; Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA., Barclay-Buchanan CJ; Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA., Hekman DJ; Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA., Mao L; Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA., Pickhardt PJ; Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA., Lubner MG; Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Jazyk: angličtina
Zdroj: Abdominal radiology (New York) [Abdom Radiol (NY)] 2022 Aug; Vol. 47 (8), pp. 2956-2967. Date of Electronic Publication: 2022 Jun 23.
DOI: 10.1007/s00261-022-03574-6
Abstrakt: Objective: Evaluate the impact of positive oral contrast material (POCM) for non-traumatic abdominal pain on diagnostic confidence, diagnostic rate, and ED throughput.
Materials and Methods: ED oral contrast guidelines were changed to limit use of POCM. A total of 2,690 abdominopelvic CT exams performed for non-traumatic abdominal pain were prospectively evaluated for diagnostic confidence (5-point scale at 20% increments; 5 = 80-100% confidence) during a 24-month period. Impact on ED metrics including time from CT order to exam, preliminary read, ED length of stay (LOS), and repeat CT scan within 7 days was assessed. A subset of cases (n = 729) was evaluated for diagnostic rate. Data were collected at 2 time points, 6 and 24 months following the change.
Results: A total of 38 reviewers were participated (28 trainees, 10 staff). 1238 exams (46%) were done with POCM, 1452 (54%) were performed without POCM. For examinations with POCM, 80% of exams received a diagnostic confidence score of 5 (mean, 4.78 ± 0.43; 99% ≥ 4), whereas 60% of exams without POCM received a score of 5 (mean, 4.51 ± 0.70; 92% ≥ 4; p < .001). Trainees scored 1,523 exams (57%, 722 + POCM, 801 -POCM) and showed even lower diagnostic confidence in cases without PCOM compared with faculty (mean, 4.43 ± 0.68 vs. 4.59 ± 0.71; p < 0.001). Diagnostic rate in a randomly selected subset of exams (n = 729) was 54.2% in the POCM group versus 56.1% without POCM (p < 0.655). CT order to exam time decreased by 31 min, order to preliminary read decreased by 33 min, and ED LOS decreased by 30 min (approximately 8% of total LOS) in the group without POCM compared to those with POCM (p < 0.001 for all). 205 patients had a repeat scan within 7 days, 74 (36%) had IV contrast only, 131 (64%) had both IV and oral contrast on initial exam. Findings were consistent both over a 6-month evaluation period as well as the full 24-month study period.
Conclusion: Limiting use of POCM in the ED for non-traumatic abdominal pain improved ED throughput but impaired diagnostic confidence, particularly in trainees; however, it did not significantly impact diagnostic rates nor proportion of repeat CT exams.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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