D. Soares1, K. M. Pal1 1Aga Khan University Medical College,Surgery,Karachi, Sindh, Pakistan
Introduction:
Acute abdomen accounts for 5-10% of visits to the ER. An early and accurate diagnosis is essential in the management of these patients. Usually the first radiological investigation performed is an abdominal X-ray. However in most cases an abdominal X-ray is unable to reach a diagnosis and the patient then has to undergo further investigations. In our study, we wished to establish in how many patients presenting to the ER with acute abdominal pain was an abdominal X-ray done unnecessarily and did not lead to a final diagnosis.
Methods:
This was a cross-sectional study conducted at the Department of Surgery at Aga Khan University Hospital over a 6 month period from April to October 2016. Patients aged 16 to 60 years of any gender, who presented to the ER with non-traumatic abdominal pain, lasting more than 2 hours and less than 5 days in duration, and which measured more than 5 on the VAS were included in the study. The patients who presented with acute abdomen and undergoing an abdominal X-ray were followed. The principal investigator then reviewed how helpful the X-ray was in the diagnosis, and calculated the proportion of X-rays that were done unnecessarily. Data was analysed using SPSS version 19.
Results:
A total of 110 patients were included in the study.
The initial diagnosis was intestinal obstruction in 47.3% (n=52), followed by acute pancreatitis in 15.5% (n=17), peritonitis in 9.1% (n=10), constipation in 8.2% (n=9), acute cholecysitis 5.5% (n=6) and acute appendicitis in 4.5% (n=5).
The x-ray findings included a non-specific bowel gas pattern in 50% (n= 55). Significant findings included dilated small bowel loops in 23.6% (n=26) and fecal loading in 19.1% (n=21); air fluid levels, calcific opacity in the right lumbar region, dilated large bowel loops in 1.8% respectively; and diffuse haziness in the abdomen and a foreign body in 1 patient respectively.
The most common final diagnoses were intestinal obstruction (27.3%), acute pancreatitis (14.5%) and constipation (10%).
The proportion of unnecessary X-rays was found to be 69.1% (n=76) with only 30.9% (n=34) actually leading to a final diagnosis.
We stratified different variables on the basis of the necessity of the x-ray. The location of pain (p = 0.007), the x-ray findings (p = 0.000) and the final diagnosis (p = 0.000) was found to be significantly associated with the unnecessary use of x-rays. Abdominal x-ray was found to have some usefulness in intestinal obstruction, ureteric caluclus, foreign body and constipation in geriatric patients. It was also found that the visual analog scale had a significant association with the use of unnecessary x-rays. On further analysis, it was found that patients with a VAS of 8 and above were more likely to have an unnecessary x-ray as opposed to patients with a VAS of 6-7.
Conclusion:
The abdominal X-ray for acute abdomen was done unnecessarily in 69% of the patients presenting with acute abdomen.