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Impact of clinical information on CT diagnosis by radiologist and subsequent clinical management by physician in acute abdominal pain

  • Emergency Radiology
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Abstract

Objective

The impact of clinical information on radiological diagnoses and subsequent clinical management has not been sufficiently investigated. This study aimed to compare diagnostic performance between radiological reports made with and without clinical information and to evaluate differences in the clinical management decisions based on each of these reports.

Methods

We retrospectively reviewed 410 patients who presented with acute abdominal pain and underwent unenhanced (n = 248) or enhanced CT (n = 162). Clinical information including age, sex, current and past history, physical findings, and laboratory tests were collected. Six radiologists independently interpreted CTs that were randomly assigned with or without clinical information, made radiological diagnoses, and scored the diagnostic confidence level. Four general and emergency physicians simulated clinical management (i.e., followed up in the outpatient clinic, hospitalized for conservative therapy, or referred to other departments for invasive therapy) based on reports made with or without the clinical information. Reference standards for the radiological diagnoses and clinical management were defined by an independent expert panel.

Results

The radiological diagnoses made with clinical information were more accurate than those made without clinical information (93.7% vs. 87.8%, p = 0.008). Median interpretation time for radiological reporting with clinical information was significantly shorter than that without clinical information (median 122.0 vs. 139.0 s, p < 0.001). Clinical simulation better matched the reference standard for clinical management when radiological diagnoses were made with reference to clinical information (97.3% vs. 87.8%, p < 0.001).

Conclusion

Access to adequate clinical information enables accurate radiological diagnoses and appropriate subsequent clinical management of patients with acute abdominal pain.

Key Points

Radiological interpretation improved diagnostic accuracy and confidence level when clinical information was provided.

Providing clinical information did not extend the interpretation time required by radiologists.

Radiological interpretation with clinical information led to correct clinical management by physicians.

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Abbreviations

AUC:

Area under the curve

CM+ :

Clinical management based on radiological report made with clinical information

CM–:

Clinical management based on radiological report made without clinical information

IDI:

Integrated discrimination improvement

NRI:

Net reclassification improvement

NSAP:

Non-specific abdominal pain

PACS:

Picture archiving and communication systems

RD+:

Radiological diagnosis made with clinical information

RD–:

Radiological diagnosis made without clinical information

RSRD:

Reference standard for radiological diagnosis

RSCM:

Reference standard of clinical management

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The authors state that this work has not received any funding.

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Correspondence to Hajime Yokota.

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The scientific guarantor of this publication is Hajime Yokota.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Informed consent was obtained in the form of opt-out; those who opted out were excluded from the study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• diagnostic or prognostic study

• multicenter study

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Hattori, S., Yokota, H., Takada, T. et al. Impact of clinical information on CT diagnosis by radiologist and subsequent clinical management by physician in acute abdominal pain. Eur Radiol 31, 5454–5463 (2021). https://doi.org/10.1007/s00330-021-07700-8

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  • DOI: https://doi.org/10.1007/s00330-021-07700-8

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