Emergency physicians recorded their presumptive diagnoses after examining patients and before the CT scan was performed. Key findings were that CT scanning increased diagnostic certainty from 70% to 90% and resulted in changes in patient treatment plans in 42%. In addition, 25% of patients initially diagnosed with a problem thought to require surgery were discharged from the emergency department without further treatment.
The most common problems encountered were ureteral stones, bowel obstruction and no acute condition, which was thought to be the diagnosis in 77 patients before CT scanning. Post-CT scan, the number of patients with no acute condition was 174, representing a 126% increase in that finding.
The paper did not address cost or radiation exposure. Asked about radiation exposure, lead author Hani H. Abujudeh, M.D. said in an email, radiation to the patient can be decreased “…using the latest technologies [and] knowledge we have.”
A surgeon, who asked to remain anonymous, reviewed the paper and offered a different interpretation of the data. He said that based on the nearly 50% post-CT rate of change in the diagnoses of appendicitis and bowel obstruction, one could simply say that the emergency department physicians at MGH are not particularly astute diagnosticians. He went on to say that the use of CT scans for abdominal pain is so common at his hospital, “if you complain of abdominal pain to the [emergency department] triage nurse, you are given your [oral] contrast to drink while you are still in the waiting room!”
This paper will no doubt be cited as justification for the increasing use of CT scanning in the diagnosis of abdominal pain. The blogger Skeptical Scalpel has commented that the quest for diagnostic accuracy trumps concerns about radiation.