Findings from a recent Beaumont Health System study encourages hospital ER staff to be more prudent before ordering a repeat CT scan for patients with nontraumatic abdominal pain. Their research demonstrated that repeat CT scans, after a negative initial scan, had a significantly lower diagnosis rate. A consequent reduction in CTs would decrease the patients’ exposure to radiation. It would also reduce costs and result in high-value health care.

Nontraumatic abdominal pain is one of the most common reasons for a trip to the emergency room. It accounts for nearly 10 percent of all ER visits. Over the past 20 years, the use of abdominal CT scans to evaluate these patients in the ER has increased dramatically.

Repeat CTs for patients with nontraumatic abdominal pain accounts for nearly half of all the CT scans done in the ER. More than half of the imaging procedures do not reveal the cause of the pain. Abdominal CTs expose patients to radiation and are expensive.

“Our study suggests that medical teams in the ER should be more cautious in ordering repeat abdominal CTs when the initial CT is negative,” explains Mitchell Cappell, M.D., Ph.D., chief, Gastroenterology, Beaumont Hospital, Royal Oak. “This should not only reduce the patient’s exposure to potentially harmful radiation, but also medical costs.”

The study, “Utility of Repeated Abdominal CT Scans After Prior Negative CT Scans in Patients Presenting to ER with Nontraumatic Abdominal Pain” was recently published in the Digestive Diseases and Sciences. All three authors – Borko Nojkov, M.D., Michael Duffy, M.D., and Mitchell Cappell, M.D, Ph.D., are Beaumont Health System physicians.

Because there is little data on the diagnostic value of repeated abdominal CT scans on repeat ER visits after an initially negative scan on an initial ER visit, Beaumont researchers set out to compare diagnostic rates. They also sought to determine if they could decrease the patient’s risk of radiation exposure.

Adds Dr. Cappell, “Among  the 200 study patients who underwent multiple CTs, we found the diagnosis rate for initial CTs was significantly higher than diagnosis rates for second, third and fourth CTs when the initial CT scan was negative. For example, the CT diagnosis rate was significantly higher in 100 patients undergoing a single CT versus 155 patients undergoing repeat CTs when the initial CT was negative: 46.5 percent versus 6.5 percent.”

While the researchers had only a moderately large number of study patients, Dr. Cappell says, “The primary study finding, a lower diagnosis rate in patients undergoing repeat CTs in comparison to patients undergoing initial or single CTs, is significant. This finding warrants confirmation in further studies. The implications from the perspectives of patient safety and medical cost containment are important.”

The researchers found APACHE-II scores, a standard sickness score used in ICUs; and white blood cell counts may help predict a positive finding on a CT scan. In addition, they have practical suggestions for ER staff when considering a repeat CT for nontraumatic stomach pain:
•       Present the case to the most senior physician on the team
•       Offer education/tutorials to physicians and radiologists

Dr. Cappell and his team want to build on the findings from this retrospective study, which analyzed patient charts from 2007-2010, by performing a larger prospective study. The follow-up research would allow the team to be involved in the care of patients in the ER at Beaumont, Royal Oak with the goal of improving patient safety.