Ability of CT to alter decision making in elderly patients with acute abdominal pain

Abstract

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.