Imaging recommendations during the Covid pandemic for the investigation of right iliac fossa pain: An unachievable and unnecessary burden on radiology services?

ABSTRACT

Aims: Initial Covid-19 surgical guidance, produced without radiological input, recommended that patients with right iliac fossa (RIF) pain should have imaging before intervention. This study quantified The burden On imaging services from these guidelines. Method(s) Patients who presented to our surgical unit with RIF pain from March to October 2020 were identified. Clinical parameters, radiology and final diagnosis were recorded. Minimum follow-up was 12 months to identify re-admissions and morbidity. Result(s) There were 417 patients. There was a drop in admissions in The first months of each new wave of Covid (March/April, September/October) compared with intervening months (36% vs. 64%, P=0.036). 266 patients (64%) had a CT scan increasing from 42% of patients in March to 75% in September (P=0.019). The proportion of patients with normal imaging increased correspondingly with over a third (34%) of CT scans being normal. 93 CT scans (35%) showed appendicitis, which was The suspected diagnosis in all but 7 of these patients. Patients with normal imaging had lower white cell counts (Mean 10.1x109 vs. 14.8x109/L, P<0.001) and CRps (Mean 21 vs. 99, P<0.001). Patients seen first by a consultant were less likely to require imaging. Conclusion(s) During The first year of Covid-19, two-thirds of patients with RIF pain had a CT scan with a third being normal. Most scans showing appendicitis had clinical parameters consistent with this diagnosis. Current guidelines may lead to unsustainable pressures On radiology services;ensuring consultant assessment prior to imaging requests may reduce The burden On these teams.