Early routine (erCT) versus selective computed tomography (sCT) for acute abdominal pain: A systematic review and meta-analysis of randomised trials

Abstract

Background: There are ongoing controversies about the routine use of computed tomography (CT) in the evaluation of acute abdominal pain (AAP), our study was designed to evaluate the impacts of early routine use CT (erCT) and selective CT (sCT) on clinical outcomes.

Methods: We conducted a meta-analysis of randomized trials. We included non-quadrant and non-region-specific studies only. The primary outcomes were the number of correct diagnoses at 24 h, mortality, and length of stay (LOS). The secondary outcomes were the number of corrected diagnoses from an initial misdiagnosis, major changes in management, and non-specific abdominal pain (NSAP).

Results: 6 Studies from 3 RCTs were included, enrolling 570 patients. erCT showed a higher number of correct diagnoses and corrected diagnoses at 24 h, [risk ratio (RR) 1.13, 95% confidence interval (CI) 1.01-1.26, P = 0.03] and [RR 1.36, 95% CI 1.01-1.85, P = 0.04] respectively, and a lower mortality at 6 months [RR 0.36, 95% CI 0.15-0.87, P = 0.02]. However, no differences were shown in LOS [mean difference (MD) -0.65, 95% CI -2.88 - 1.58, P = 0.57], major changes in management [RR 1.45, 95% CI 0.94-2.22, P = 0.09] and NSAP [RR 0.92, 95% CI 0.57-1.50, P = 0.74].

Conclusion: erCT has demonstrated both diagnostic and survival benefits by having more correct diagnoses at 24 h and lower mortality at 6 months. Further study should focus on determining the subpopulation that would most benefit from the potentially differential effects of erCT.

Keywords: Abdominal pain; Diagnosis; Length of stay; Mortality; Tomography; X-ray computed.