The Appropriate Use of Conventional Abdominal Radiographs and Its Usefulness in Non-Traumatic Acute Abdomen Patients

  • Sornsupha Limchareon Division of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand 20131
  • Alisara Wongsuttilert Division of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand 20131
  • Chuenrutai Yeekian Queen Sawangawattana Memorial Hospital, Chonburi, Thailand 20110
  • Lalitphan Nimmankiatkul Queen Sawangawattana Memorial Hospital, Chonburi, Thailand 20110
Keywords: Abdominal radiograph, Acute abdominal pain, Appropriateness criteria, Imaging

Abstract

Objective: Conventional abdominal radiographs (CAR) are often ordered in patients presented with acute abdominal pain. We investigated the appropriate use of CAR and its usefulness in the Emergency Department (ED).


Methods: Adult patients who had CAR ordered from ED between 1st September and 31st October 2018 were retrospectively reviewed. Patients' demographics, indications for CAR, CAR results, further imaging, and their results, and final diagnoses were assessed. The appropriate or inappropriate use of CAR was stratified. A comparison between the appropriate group and inappropriate group was made.


Results: There were 154 CAR studies, M:F = 57:97, mean age 48.3 years (ranged 15 - 88 years). 33.8% of CAR was considered an appropriate use. Of the 154 examinations, 17 (11%), 73 (47%), and 64 (42%) were reported as positive, negative, and non-diagnostic results by CAR respectively. A comparison between appropriate and inappropriate groups, number of cases, CAR negative results, CAR non-diagnostic result, and negative further imaging results were significantly different. There was no statistical difference in the number of further imaging between both groups. The common findings of positive results that had no further imaging were bowel obstruction (n = 6), followed by bowel perforation (n = 3). 12 out of 73 (16.4%) negative CAR results, and 11 out of 64 (17%) of non-diagnostic results had positive findings from further imaging.


Conclusion: The appropriate use of CAR in non-traumatic acute abdomen patient in our institution is only 33.8%. More precise imaging is required to make a decision whether appropriate indication or not. Strict to the protocols, staff education and internal audit should be performed in the hospital.

Downloads

Download data is not yet available.

References

1. MacKersie AB, Lane MJ, Gerhardt RT, et al. Nontraumatic acute abdominal pain: unenhanced helical CT compared with threeview acute abdominal series. Radiology. 2005;237:114-122.
2. Van Randen A, Laméris W, Luitse JS, et al. The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med. 2011;29:582-589.
3. Kellow ZS, MacInnes M, Kurzencwyg D, et al. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology. 2008;248:887-893.
4. Stoker J, Van Randen A, Laméris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2008;253:31-46.
5. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol. 2018;15:S217-S231.
6. Prezzia C, Vorona G, Greenspan R. Fourthyear medical student opinions and basic knowledge regarding the field of radiology. Acad Radiol. 2013;20:272-283.
7. Saha A, Roland RA, Hartman MS, Daffner RH. Radiology medical student education: an outcome-based survey of PGY-1 residents. Acad Radiol. 2013;20:284-289.
8. Dym RJ, Burns J, Taragin BH. Appropriateness of imaging studies ordered by emergency residents: results of an online survey. Am J Roentgenol. 2013;201:619-625.
9. Bautista AB, Burgos A, Nickel BJ, Yoon JJ, Tilara AA, Amorosa JK. Do clinicians use the American College of Radiology Appropriateness Criteria in the management of their
patients?. Am J Roentgenol. 2009;192:1581-1585.
10. Assarian A, Zaidi AZ, Chung R. Plain abdominal radiographs and acute abdominal pain. Professional Med J. 2008;15:33-36.
11. Morris-Stiff G, Stiff R, Morris-Stiff H. Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting. Ann
R Coll Surg Engl. 2006;88:270-274.
12. Sreedharan S, Fiorentino M, Sinha S. Plain abdominal radiography in acute abdominal pain-is it really necessary?. Emerg Radiol.2014;21:597-603.
13. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation.
Radiology. 2002;225:159-164.
14. Dubuisson V, Voïglio EJ, Grenier N, Le Bras Y, Thoma M, Launay-Savary MV. Imaging of non-traumatic abdominal emergencies in adults. J Visc Surg. 2015;152:57-64.
15. Fargo R, Ramirez E, Millan M, Kreisler E, Del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207:
127-138.
16. Lo Re G, Mantia FL, Picone D, Salerno S, Vernuccio F, Midiri M. Small Bowel Perforations: What the Radiologist Needs to Know. Semin Ultrasound CT MRI. 2016;37:23-30.
17. Giljaca V, Nadarevic T, Poropat G, Nadarevic VS, Stimac D. Diagnostic accuracy of abdominal ultrasound for diagnosis of acute appendicitis: systematic review and metaanalysis.World J Surg. 2017;41:693-700.
18. Van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression
US related to prevalence of disease. Radiology. 2008;249:97-106.
19. Lipkin ME, Preminger GM. Imaging techniques for stone disease and methods for reducing radiation exposure. Urol Clin N Am. 2013;40:47-57.
20. Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2009;23:9-20.
21. Chawla A, Bosco JI, Lim TC, Srinivasan S, Teh HS, Shenoy JN. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.
Singapore Med J. 2015;56:438-443.
22. Bulakci M, Kalelioglu T, Bulakci BB, Kiris A. Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing. Eur J Radiol.
2013;82:1248-1254.
23. Schulz B, Grossbach A, Gruber-Rouh T, Zangos S, Vogl TJ, Eichler K. Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT
protocol as a diagnosis tool for body packers. Clin Radiol. 2014;69:525-530.
Published
2021-04-27
Section
Original Articles