Subject(s)
Education, Medical, Undergraduate , Radiology , Students, Medical , Canada , Humans , Perception , Radiology/educationSubject(s)
Crohn Disease/diagnostic imaging , Crohn Disease/therapy , Magnetic Resonance Imaging , Abdominal Abscess/diagnostic imaging , Abdominal Abscess/etiology , Adolescent , Adult , Aged , C-Reactive Protein/metabolism , Cellulitis/diagnostic imaging , Cellulitis/etiology , Crohn Disease/complications , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
PURPOSE: To characterize the utility of abdominal radiography for nontrauma emergency patients in a single-institution setting. MATERIALS AND METHODS: Following approval from the Director of Professional Services, a retrospective review of radiography and of patient records was conducted for patients who presented to a nontrauma emergency department over a period of 6 months and who were imaged by using abdominal radiography. Only the first radiograph per patient was used for analysis. The interpretations were sorted as normal, nonspecific, or abnormal. The patients' medical records were reviewed to determine whether further imaging was performed (computed tomography, ultrasonography, or upper gastrointestinal imaging) and results were compared with abdominal radiography. Chart reviews were conducted to identify patients in whom abdominal radiography alone influenced treatment. RESULTS: In 874 patients, interpretation of abdominal radiography was normal in 34% (n = 300), nonspecific in 46% (n = 406), and abnormal in 19% (n = 168). Further imaging was performed for 50% (436) of all patients. Of 300 patients whose abdominal radiography results were normal, 42% (n = 125) had follow-up imaging; 72% (n = 90) of these showed abnormal, 78% (165 of 212) showed nonspecific, and 87% (86 of 99) showed abnormal findings. Of 438 patients who did not undergo follow-up imaging, 75% (n = 327) were discharged. For all indications other than catheter placement, abdominal radiography helped confirm the suspected diagnosis in 2%-8% of cases. In 37 (4%) of 874 patients, abdominal radiography was possibly helpful in changing patient treatment without a follow-up study. CONCLUSION: Abdominal radiography is often requested; however, its results contribute to patient treatment in a small percentage of cases. With the exception of catheter placement, if a patient requires investigation beyond clinical history, physical examination, and lab results, the emergency physician should be encouraged to request more definitive imaging.
Subject(s)
Abdomen, Acute/diagnostic imaging , Abdomen, Acute/epidemiology , Emergency Medical Services/statistics & numerical data , Health Services Misuse/statistics & numerical data , Radiography, Abdominal/statistics & numerical data , Incidence , Internationality , United States , Wounds and Injuries/diagnostic imagingABSTRACT
Diagnostic imaging plays a crucial frontline role in healthcare, providing the information some physicians need to make a diagnosis and determine a course of treatment for their patients. However, wait times for access to diagnostic imaging examinations continue to be long. This is due to a number of factors, including the expanding indications for CT and MRI and growing reliance on imaging studies, Canada's lag in purchasing new equipment, an American influence on the Canadian healthcare system and clinicians' requests for inappropriate examinations. A number of strategies need to be implemented to maximize radiology's efficiency and ensure that services are being used appropriately. The author advocates the use of appropriateness guidelines for referring physicians, delisting tests that are completely inappropriate, implementing the use of radiology information systems, enhancing radiologist efficiency and using physician extenders to perform less complex medical work.
