Journal Article

Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

Sebbane, Mustapha, Pages-Bouic, Emma, Taourel, Patrice, Millet, Ingrid, Curros-Doyon, Fernanda, Riou, Bruno, Molinari, Nicolas

2017

Overview

Objectives To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Methods Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up. Results Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p =1.1x10 -6 ) and management (88.5% to 95.8%, p =2.6x10 -6 ) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. Conclusions Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice. Key Points • Systematic unenhanced CT improves significantly diagnosis accuracy compared to current practice. • Systematic unenhanced CT optimizes appropriate hospitalization by increasing the number of discharged patients. • Systematic unenhanced CT allows detection of about one-third of acute unsuspected abdominal conditions. • It should allow boosting emergency department management decision-making confidence in old patients.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag
• Subject: Abdomen / Abdominal Pain - diagnostic imaging / Abdominal Pain - etiology / Accuracy / Acute Disease / Age / Aged / Aged, 80 and over / Aortic Diseases - complications / Aortic Diseases - diagnostic imaging / Appendicitis - complications / Appendicitis - diagnostic imaging / Biliary Tract Diseases - complications / Biliary Tract Diseases - diagnostic imaging / Clinical Decision-Making / Colitis - complications / Colitis - diagnostic imaging / Contrast Media / Diagnostic Radiology / Digestive System Diseases - complications / Digestive System Diseases - diagnostic imaging / Diverticulitis - complications / Diverticulitis - diagnostic imaging / Emergency medical care / Emergency Radiology / Emergency Service, Hospital / Fecal Impaction - complications / Fecal Impaction - diagnostic imaging / Female / Humans / Imaging / Informed consent / Internal Medicine / Interventional Radiology / Intestinal Obstruction - complications / Intestinal Obstruction - diagnostic imaging / Intestinal Pseudo-Obstruction - complications / Intestinal Pseudo-Obstruction - diagnostic imaging / Kidney Diseases - complications / Kidney Diseases - diagnostic imaging / Life Sciences / Male / Medical imaging / Medicine / Medicine & Public Health / Mesenteric Ischemia - complications / Mesenteric Ischemia - diagnostic imaging / Mortality / Neuroradiology / Pain / Pancreatitis - complications / Pancreatitis - diagnostic imaging / Patient Discharge / Peptic Ulcer - complications / Peptic Ulcer - diagnostic imaging / Prospective Studies / Pyelonephritis - complications / Pyelonephritis - diagnostic imaging / Radiology / Renal Colic - complications / Renal Colic - diagnostic imaging / Review boards / Santé publique et épidémiologie / Surgery / Tomography / Tomography, X-Ray Computed - methods / Ultrasound