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Introduction: The purpose of this study was to document, classify, and analyze the rationale behind the use of abdominal radiography (AXR) by Emergency Department physicians (EDMDs) in the setting of acute non-traumatic abdominal pain.
Methods: A prospective observational cohort study of EDMDs in the diagnostic evaluation of patients with acute, non-traumatic abdominal pain for whom AXR was requested. Prospectively acquired data included the experience level of the EDMD, the provisional diagnosis prior to AXR, the likely impact of the results on the decision to order further imaging, and the EDMDs’ estimate of the likelihood of having a positive finding on AXR.
Results: Results from 169 patients were included. The most common provisional diagnoses provided at the time of ordering the AXR were obstruction (43%), constipation (14.8%), perforation (8.3%), non-specific abdominal pain (6.5%), renal colic (3.6%) and other (18.9%). The reason for ordering the AXR was to establish the provisional diagnosis (44.4%), to exclude a more serious diagnosis (33.1%) and other (20.7%). Overall 70.4% of AXRs were interpreted as normal, 23 (13.6%) of the studies were read as positive with 78% of these being positive for small bowel obstruction. An additional 27 (16%) studies were equivocal. In 40% of patients with an AXR, no CT was obtained later.
Conclusion: Physicians’ pretest probability of a positive finding was found to increase the likelihood of a positive AXR. By limiting the use of AXR to specific diagnoses and guided by the physician’s own determination of likelihood of positive results, imaging resources might be able to be used more efficiently, decreasing patient’s length of stay, radiation exposure, and technician’s and physician’s time.