Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. Export

@article{citeulike:5041342, abstract = {OBJECTIVE: To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. DESIGN: Fully paired multicentre diagnostic accuracy study with prospective data collection. SETTING: Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. PARTICIPANTS: 1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. INTERVENTION: All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. MAIN OUTCOME MEASURES: Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. RESULTS: 661 (65\%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89\% (95\% confidence interval 87\% to 92\%) for CT and 70\% (67\% to 74\%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6\% of urgent cases. With this strategy, only 49\% (46\% to 52\%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. CONCLUSION: Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.}, author = {Lam\'{e}ris, Wytze and van Randen, Adrienne and van Es, H. Wouter and van Heesewijk, Johannes P. and van Ramshorst, Bert and Bouma, Wim H. and ten Hove, Wim and van Leeuwen, Maarten S. and van Keulen, Esteban M. and Dijkgraaf, Marcel G. and Bossuyt, Patrick M. and Boermeester, Marja A. and Stoker, Jaap and {OPTIMA study group}}, citeulike-article-id = {5041342}, citeulike-linkout-0 = {http://dx.doi.org/10.1136/bmj.b2431}, citeulike-linkout-1 = {http://bmj.com/cgi/content/abstract/338/jun26_2/b2431}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/19561056}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=19561056}, doi = {10.1136/bmj.b2431}, issn = {1468-5833}, journal = {BMJ (Clinical research ed.)}, keywords = {abdomen, abdominal, acute, pain}, month = {June}, number = {jun26\_2}, pages = {b2431+}, posted-at = {2009-07-04 00:38:48}, priority = {2}, title = {Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study.}, url = {http://dx.doi.org/10.1136/bmj.b2431}, volume = {338}, year = {2009} }

TY - JOUR ID - citeulike:5041342 L3 - citeulike-article-id:5041342 N2 - OBJECTIVE: To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. DESIGN: Fully paired multicentre diagnostic accuracy study with prospective data collection. SETTING: Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. PARTICIPANTS: 1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. INTERVENTION: All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. MAIN OUTCOME MEASURES: Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. RESULTS: 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. CONCLUSION: Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation. IS - jun26_2 JF - BMJ (Clinical research ed.) SN - 1468-5833 TI - Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. VL - 338 SP - b2431 KW - abdomen KW - abdominal KW - acute KW - pain AU - Laméris, Wytze AU - van Randen, Adrienne AU - van Es, Wouter AU - van Heesewijk, Johannes AU - van Ramshorst, Bert AU - Bouma, Wim AU - ten Hove, Wim AU - van Leeuwen, Maarten AU - van Keulen, Esteban AU - Dijkgraaf, Marcel AU - Bossuyt, Patrick AU - Boermeester, Marja AU - Stoker, Jaap PY - 2009/06/26/ UR - http://dx.doi.org/10.1136/bmj.b2431 ER -