Avoiding Repeat Computed Tomography in Patients With Recurrent Abdominal Pain

Document Type

Conference Proceeding

Publication Date

4-20-2023

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Imaging with computed tomography of the abdomen and pelvis (CTAP) in the has surged over time without improved patient safety. Low-value, repeated imaging is common in the evaluation of recurrent abdominal pain, and recent emergency care guidelines have identified a lack of evidence in this area. The primary objective of this study was to explore development of a clinical decision support tool in the emergency department (ED) evaluation of recurrent abdominal pain. Methods: We performed an observational cohort study using electronic health data of adult patients with recurrent abdominal pain presenting to 8 EDs who had at least one CTAP performed within the past 12 months. We excluded patients who were <18 years, were pregnant, had abdominal surgery < 30 day or had inflammatory bowel disease. We obtained clinical characteristics and reviewed outcomes over 30 day following the ED visit. We classified patients as having low-risk recurrent abdominal pain if pre-defined emergent conditions were absent. Analysis was conducted with descriptive statistics and multivariable logistic regression models. Results: The study included 423 ED patients with recurrent abdominal pain. The mean age was 51.6 (standard deviation 16.8) years, and the median pain severity was 8 [interquartile range 7, 10]. There were 192 (45.4%) patients that had 2 or more CTAP performed in the preceding 12 months. Emergent conditions were present in 84 (19%) patients. Significant adjusted predictors of low-risk recurrent abdominal pain included: age < 65 years (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.16-0.54), absent alcohol use (OR 0.50, 95% CI 0.28-0.88), absent RUQ pain (OR 0.46, 95% CI 0.24-0.87), absent peritoneal signs (OR 0.24, 95% CI 0.11-0.50), white blood cell count < 10,000 cells/uL (OR 0.36, 95% CI 0.21-0.64), and systolic blood pressure >100 mm Hg (OR 0.149, 95% CI 0.037-0.61). Conclusion: Common clinical characteristics have the potential to aid clinicians in avoiding low-value CTAP testing in patients presenting to the ED with recurrent abdominal pain. This work provides an exploratory rubric for prospective studies to develop clinical decision support in this area.

Volume

30

First Page

124

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