Abdominal/Pelvic CT Scans ordered Pre-Physical Exam in the Emergency Department, A Pilot Study

Introduction: Computerized tomography (CT) scans are effective for evaluating abdominal pain, a common emergency department (ED) complaint. In ED “physician in triage” (PIT) models, CTs can be ordered in triage. PIT has been shown to have higher clinical yield of abdominal/pelvic CTs than the traditional ED model. We explored the benefit versus radiation risk of abdominal/pelvic CTs ordered in an ED where physicians may order CTs in triage (pre-PE) to determine if results were similar to post physical exam (post PE) CTs. Methods: In this retrospective study at Berkshire Medical Center in Pittsfield, Massachusetts, 969 patients had abdominal/pelvic CTs in the ED from June 1, 2022, to August 31, 2022. Inclusion criteria were ED patients aged 8 to 80 who received an abdominal/pelvic CT; 706 met criteria. Exclusion criteria were trauma, repeat abdominal pain ED visit within three-months, and history of gastric bypass. Records were reviewed for sex, chief complaint, abdominal PE findings, CT reports, number of abdominal/pelvic CTs within the year, and CT order and physician sign up times to determine whether CT was ordered pre-PE or post-PE. The deidentified data was analyzed with chi square and t-tests, p value of 0.05 was considered significant. Results: More positive CTs were ordered pre-PE versus post-PE (p=0.03). Of the 65 pre-PE CTs, 41 (63.1%) had positive CTs, 24 (36.9%) had negative CTs. Of 641 post PE CTs, 314 (49.0%) had positive CTs, 327 (51.0%) had negative CTs. Overall, 355 (50.3%) had positive CTs, 351 (49.7%) had negative CTs; 493 (69.8%) had no prior abdominal/pelvic CTs in the year, 213 (30.8%) had one or more abdominal/pelvic CTs. There was no difference in the number of prior abdominal/pelvic CTs in relation to current CT results (p=0.42). Males pre-PE CTs were more likely to be positive (p=0.05), females did not have a difference (p=0.30). Conclusion: In this traditional ED without a PIT model, patients with abdominal pain were more likely to have positive CTs when ordered pre-PE, consistent with PIT model studies. These results can guide protocols for ordering abdominal/pelvic CTs pre-PE in EDs, possibly reducing wait times and radiation exposure. Keywords PIT ED model, pre-PE, abdominal/pelvic CT, ED triage