Digestive Diseases and Sciences

, Volume 58, Issue 4, pp 1074–1083

Utility of Repeated Abdominal CT Scans After Prior Negative CT Scans in Patients Presenting to ER with Nontraumatic Abdominal Pain

  • Borko Nojkov
  • Michael C. Duffy
  • Mitchell S. Cappell
Original Article

DOI: 10.1007/s10620-012-2473-0

Cite this article as:
Nojkov, B., Duffy, M.C. & Cappell, M.S. Dig Dis Sci (2013) 58: 1074. doi:10.1007/s10620-012-2473-0

Abstract

Purpose

The purpose of this study was to analyze diagnostic yield of repeat computed tomography (CT) after negative initial CT versus yield of initial CT in patients presenting repeatedly to emergency room (ER) for nontraumatic abdominal pain. Medical costs and radiation exposure from repeat CT could be reduced if repeat CT after negative initial CT has a low diagnostic yield.

Methods

Patients included consecutive adults presenting to William Beaumont Hospital, from 2007 to 2010, undergoing abdominal CT for nontraumatic abdominal pain retrospectively identified by medical diagnostic and CT procedural codes. Exclusion criteria were prior abdominal trauma, recent abdominal surgery, and known chronic gastrointestinal disease. The CT was labeled “positive” if findings explained patient’s abdominal pain or was clinically significant. Positivity rate was compared for repeat versus initial CT.

Results

Among 200 consecutive patients undergoing (659) multiple CTs (mean age = 45.7 years, 74 % female), positivity rate for initial CT (22.5 %) was significantly higher than positivity rates for CT#2 (8.4 %, p = 0.002), for CT#3 (4.9 %, p = 0.005), and for CT ≥ #4 (5.9 %, p = 0.006). Generally, CT positivity rate declined with increasing number of prior negative CTs. CT positivity rate was significantly higher in 100 patients undergoing single CT versus 155 patients undergoing repeat CTs (46.5 vs. 6.5 %, p = 0.0001). Positive repeat CT findings included intestinal mural thickening/mass (7), colitis (5), appendicitis (4), and other (14). Among 15 analyzed clinical parameters, two significantly predicted repeat CT positivity, namely, leukocytosis (p = 0.03) and APACHE-II-score >5 (p = 0.01). Repeat CTs constituted 47 % of all CTs.

Conclusions

Repeat abdominal CT after initially negative CT(s) performed for nontraumatic abdominal pain has a low diagnostic yield. Leukocytosis and APACHE-II score might help predict CT scan positivity. Data suggest restricted abdominal CT utilization in ER patients with multiple prior negative CTs. Findings warrant confirmation in prospective studies.

Keywords

Non-traumatic abdominal pain Abdominal pain Emergency room Abdominal CT Abdominal ultrasound Abdominal imaging Cost-containment Radiation exposure Triage 

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Borko Nojkov
    • 1
  • Michael C. Duffy
    • 1
  • Mitchell S. Cappell
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont HospitalOakland University William Beaumont School of MedicineRoyal OakUSA

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