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Unexpected changes in clinical diagnosis: early abdomino-pelvic computed tomography compared with clinical evaluation

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Abstract

Background

To evaluate the value of early computed tomography (CT) on identifying clinically “unexpected” diagnosis in patients presenting with “non specific” acute abdominal pain.

Materials and methods

All patients presenting to on-call surgeons with acute abdominal pain were eligible study participants. Patients were randomised to CT within one hour of admission or supine abdominal and erect chest radiography. Ninetynine patients randomized to CT arm were reviewed for the purpose of this study. The number and severity of unexpected and/or incidental diagnoses detected on the CT were assessed.

Results

In 20 of the 99 patients CT revealed primary or secondary diagnoses, which were unexpected following the initial clinical examination and led to completely different therapeutic options. In 15 of those 20 patients CT revealed clinically unexpected conditions, whereas in two patients severe complications of the clinically suspected diagnosis were detected on CT. Five patients had significant incidental findings in addition to their primary diagnosis on CT. In two of these patient CT also revealed clinically unexpected diagnoses.

Conclusion

Early CT has the advantage of detecting unexpected clinically significant primary and secondary diagnoses in patients presenting with acute abdominal pain and best guides the surgeon to the appropriate patient management.

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Acknowledgments

We thank the Fund for Addenbrooke’s for funding the study. We are very grateful to the staff of the emergency department and to the surgical senior house officers and registrars for their assistance with the study. We also thank the Radiography staff in the CT department for their invaluable help in achieving prompt imaging.

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Authors and Affiliations

  1. Department of Radiology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK

    Evis Sala, Clare Beadsmoore, Daniel Gibbons, Ashley Shaw, Mathew Gaskarth & Adrian K. Dixon

  2. Department Surgery, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK

    Thomas Groot-Wassink & Christopher Watson

  3. University Department of Radiology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK

    Evis Sala

Authors
  1. Evis Sala
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  2. Clare Beadsmoore
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  3. Daniel Gibbons
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  4. Ashley Shaw
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  5. Mathew Gaskarth
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  6. Thomas Groot-Wassink
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  7. Christopher Watson
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  8. Adrian K. Dixon
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Corresponding author

Correspondence to Evis Sala.

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Sala, E., Beadsmoore, C., Gibbons, D. et al. Unexpected changes in clinical diagnosis: early abdomino-pelvic computed tomography compared with clinical evaluation. Abdom Imaging 34, 783–787 (2009). https://doi.org/10.1007/s00261-007-9320-3

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  • DOI: https://doi.org/10.1007/s00261-007-9320-3

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