CT Scan Improves Accurate, Timely Diagnosis for Abdominal Issues in ED

If a CT scan could speed up an accurate diagnosis, increase the doctor’s confidence in that diagnosis and treatment, and decrease the number of patients kept for observation or hospital admission, wouldn’t that scan be valuable?

That’s a logical conclusion from a study just published in the February issue of the American Journal of Roentgenology. The study looked at 584 patients who underwent CT scans after presenting to Massachusetts General Hospital’s emergency department with complaints of abdominal pain but no trauma. Doctors ordering the CTs completed questionnaires before and after receiving results.

After learning of the CT scan outcomes, physicians changed their diagnoses for 49 percent of patients, and changed management plans for 42 percent, according to the study. Doctors decreased the number of those who were initially going to be kept for observation by 44 percent, while 20 percent of patients who were to be admitted were sent home instead.

The study focused on three areas: whether CT results changed the working or final diagnosis, whether it affected the physician’s confidence making the diagnosis, and whether it affected patient management.

“It had an impact on all three of those,” said Scott Gazelle, MD, MPH, PhD, senior author of the study, an MGH radiologist, and director of the Institute for Technology Assessment.

“We wanted to focus on an indication rather than looking at all CTs that are performed,” said Gazelle. “Abdominal pain is one of the more common presenting symptoms to the emergency department, for which CT is obtained.”

He said they chose to focus on abdominal pain because it’s common, and he thought they could show there was value in CT.

Gazelle noted that imaging is one targeted area in the effort to contain healthcare costs. However, the study shows that CT scans, in this instance, can help doctors make a more accurate diagnosis, possibly eliminating some additional studies, and even sending some patients home instead of admitting them.

Physicians planned to admit 75 percent of the patients to the hospital before the scan, yet after receiving results, only admitted 24 percent, with the others discharged home with follow-up.

While the study didn’t account for specific cost savings, it’s obvious that there are savings to be had. “From before CT to afterwards, the management plan was changed, such that a significant number of patients who would have been admitted for observation were admitted for definitive therapy or were discharged. So that’s a savings,” Gazelle said. “There’s always a savings when people get the right therapy and when movement is made rapidly towards a diagnosis or improved confidence in a diagnosis. The sooner you get toward that, there are opportunities to avoid other tests and time.”