TY - JOUR
T1 - Ability of CT to alter decision making in elderly patients with acute abdominal pain
AU - Esses, David
AU - Birnbaum, Adrienne
AU - Bijur, Polly
AU - Shah, Sachin
AU - Gleyzer, Aleksandr
AU - Gallagher, E. J.
PY - 2004/7
Y1 - 2004/7
N2 - The study objective was to assess the ability of computerized tomography (CT) to alter clinical decision-making in the evaluation of elderly Emergency Department (ED) patients with abdominal pain. A prospective, observational cohort study of a convenience sample of ED patients, 65 years of age, with abdominal or flank pain of 1-week duration was conducted. ED attending physicians completed a structured data collection instrument recording 5 primary endpoints before and after CT. Change in frequency of each of these 5 endpoints from pre- to post-CT comprised the target outcome variables. Of 104 eligible patients, CT altered the admission decision in 26% (95%CI 18, 34%)]; need for surgery in 12% (95% CI 6%, 18%); need for antibiotics in 21% (95% CI 13%, 29%) and suspected diagnosis in 45% (95% CI 35%, 55%). The proportion of cases in which physicians reported a high degree of certainty in the suspected diagnosis increased from 36% pre-CT (95%CI 26,44%) to 77% post-CT (95% CI 69, 85%). Diagnosis and disposition were altered by CT in about one-half and one-quarter of patients, respectively, concurrent with a doubling in diagnostic certainty. CT has the ability to significantly alter clinically important decisions in elderly patients with abdominal pain.
AB - The study objective was to assess the ability of computerized tomography (CT) to alter clinical decision-making in the evaluation of elderly Emergency Department (ED) patients with abdominal pain. A prospective, observational cohort study of a convenience sample of ED patients, 65 years of age, with abdominal or flank pain of 1-week duration was conducted. ED attending physicians completed a structured data collection instrument recording 5 primary endpoints before and after CT. Change in frequency of each of these 5 endpoints from pre- to post-CT comprised the target outcome variables. Of 104 eligible patients, CT altered the admission decision in 26% (95%CI 18, 34%)]; need for surgery in 12% (95% CI 6%, 18%); need for antibiotics in 21% (95% CI 13%, 29%) and suspected diagnosis in 45% (95% CI 35%, 55%). The proportion of cases in which physicians reported a high degree of certainty in the suspected diagnosis increased from 36% pre-CT (95%CI 26,44%) to 77% post-CT (95% CI 69, 85%). Diagnosis and disposition were altered by CT in about one-half and one-quarter of patients, respectively, concurrent with a doubling in diagnostic certainty. CT has the ability to significantly alter clinically important decisions in elderly patients with abdominal pain.
KW - Abdominal pain
KW - aged
KW - tomography
KW - x-ray computed
UR - http://www.scopus.com/inward/record.url?scp=3142753715&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=3142753715&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2004.04.004
DO - 10.1016/j.ajem.2004.04.004
M3 - Article
C2 - 15258866
AN - SCOPUS:3142753715
SN - 0735-6757
VL - 22
SP - 270
EP - 272
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 4
ER -