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Las exploraciones de CT de la tripa cambian mentes en ER: estudio

por Brendon Nafziger, DOTmed News Associate Editor | January 24, 2011
The use of computed tomography scans in the emergency room has skyrocketed in recent years, with some experts predicting that soon one-fifth of all ER visits will include a CT scan.

While this prompts some to grumble about rising medical costs, a new report suggests these CT scans are happening for a good reason. A study out this month in the American Journal of Roentgenology found that using CT scans in the ER on patients complaining of abdominal pain led to a change in diagnosis almost half the time, and cut the number of hospital admissions by nearly 20 percent.

"While we didn't include a cost analysis in our study, it is fair to say that our results suggest the CT scan might reduce the use of other tests and procedures and therefore lower overall costs," said lead author Dr. Scott Gazelle, professor of radiology with Harvard Medical School, in prepared remarks.
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The study worked by surveying doctors at Massachusetts General Hospital in Boston before and after administering scans to 584 patients who were admitted with non-traumatic abdominal pain between Nov. 2006 and Feb. 2008.

The researchers found the results of the CT scan changed the initial diagnosis for 49 percent of the patients, and boosted the doctors' confidence in the diagnosis about 31 percent.

Care plans changed, too, for about 42 percent of patients, sometimes quite dramatically. Doctors decided to discharge about a quarter of the 79 patients initially recommended for surgery after the CT scans were in, the study said.

The doctors said the results came about partly because abdominal CT scans are often useful for ruling out certain conditions that require surgery. In the study, the most common diagnoses were renal colic (20 percent) and intestinal obstruction (14 percent).

"Abdominal pain is one of the most common reasons for an emergency department visit and also poses a diagnostic challenge since it can represent a wide range of conditions, some being no cause for concern while others indicate a life threatening emergency," the Medical Imaging Technology & Technology Alliance, an imaging manufacturer trade group, said in a letter.

However, the researchers offered some caveats: the single-center study took place at a large teaching hospital, so they warn it would be hard to generalize the results to other institutions. Plus, there was no control group, and some of the before and after surveys were filled out by different doctors.

Still, the study could help put in perspective findings shared last year at the Radiological Society of North America's annual meeting. In those results, also published in the journal Radiology, researchers found the number of ER visits that included a CT scan jumped nearly six-fold from 1995 to 2007, climbing from 2.7 million to 16.2 million, an average annual increase of 16 percent.

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