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Rameen Shafiei DO

Diagnostic Utility of Repeat CT Scans of the Abdomen and Pelvis in Emergency Department Patients Presenting with Non-traumatic Abdominal Pain. Rameen Shafiei DO. Background. It is estimated that approximately 62 million CT scans are performed yearly. As compared to only 3 million in 1980 1.

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Rameen Shafiei DO

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  1. Diagnostic Utility of Repeat CT Scans of the Abdomen and Pelvis in Emergency Department Patients Presenting with Non-traumatic Abdominal Pain. Rameen Shafiei DO

  2. Background • It is estimated that approximately 62 million CT scans are performed yearly. As compared to only 3 million in 19801. • Radiation exposure, radio-contrast media (RCM) exposure, and cost can become a burden to both the patient’s health, and healthcare providers. • 29,000 future cancers would be related to the 57 million scans preformed in the United States in the year 2007. • It is approximated that 3% of patients will suffer acute renal failure following the administration of RCM. This number rises to 25% in patients with an already elevated creatinine6,7. • The diagnosis of acute renal failure while hospitalized raises the risk of mortality from 1.4% to 22%6,7.

  3. Methods • We reviewed all emergency room visits between years 2009 and 2010 • Charts displaying repeat CT scans of the abdominal and pelvis in the one-year time frame were then chosen. • Results were then separated into positive vs. negative scan, and disposition of home vs. admission/referral. • A secondary analysis was then conducted to determine if there was a correlation between certain laboratory/clinical findings and the likelihood of a positive CT scan.

  4. Results • Our search provided a total of 293 charts showing patients who received a repeat CT scan of the abdomen and pelvis. 149 of these subjects had a result that was negative, another 144 were positive. A total of 219 (75%) of these patients were sent home. • Of all the individual measures examined, none showed a significantly greater likelihood of having a positive CT scan. This may have been the result of having a small incidence size. For example, out of the 293 subjects, only four had elevated liver transaminases. Of these four patients, three had a positive CT Scan (75%).

  5. Final Disposition Admit/Referral Home

  6. Conclusions • Our study demonstrates that approximately 50% of repeat CT scans of the abdomen and pelvis will be positive. And 25% will need admission, referral, or treatment. It was expected that the likelihood of a negative scan would be higher. Our data failed to demonstrate this. We were also unable to demonstrate a correlation between abnormal laboratory studies and vital signs, and a likelihood that these findings would better predict a positive CT scan. This may have been due to several study limitations including our sample size and the aspect that both institutions function as the base site for an Emergency Medicine residency program. Possibly leading to the increased use of CT scans in the diagnostic workup. • Unfortunately, our data was unable to provide statistically important correlations that physicians could use in their decision making process. Overall, our study did demonstrate that clinicians ordered CT scans in scenarios that revealed positive result. This outcome was better than initially hypothesized, but we feel that improvement is necessary to help decrease the total amount of CT scans performed by today’s health care providers.

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