Effect of repeat abdominal CT in ED patients on diagnosis and disposition [poster]
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Objective: Computed tomography (CT) is a commonly used diagnostic resource in emergency departments and has shown utility in many clinical scenarios leading to a rapid increase in use. Recently concern has been raised as to risks from the radiation received during CT scanning, especially among patients receiving multiple CT's. We conducted surveys of providers who ordered an abdominal CT for patients that had undergone the same CT in the past year. Our goal was to evaluate the effect of CT on diagnosis and clinical management. Methods: Stable patients older than 18 who were undergoing abdominal CT were enrolled. Patients were excluded if the indication was trauma, malignancy or other chronic illness that is likely to progress. Providers were surveyed before and after the CT. Results: We enrolled 59 patients (15 male, 44 female). Average age was 48. Enrolled patients had previously been scanned median 2 times, average 3.8 times, maximum 35 times. 6 patients planning for discharge were admitted including 2 that were taken to the operating room while 9 patients planning for admission were discharged home. CT was the primary diagnostic aid for 11 of these changes. 22 patients had a change in diagnosis from an acute illness to no active disease, all based on the CT. Provider diagnostic confidence rose from 5.9 to 8.2 (1-10 scale) after CT. Conclusions: This study suggests that repeat CT is often justified. It leads to changes in diagnosis and disposition while increasing provider confidence. Patient enrollment is ongoing.