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20-Second Tool Cuts Abdominal CT Scans 10%

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A new electronic medical records tool reduces unnecessary use of CT scans for emergency-department patients with abdominal pain, according to a study by researchers at the Perelman School of Medicine at the University of Pennsylvania.

The tool asks the physician a series of questions designed to clarify exactly why the physician is ordering the CT scan. Doctors are asked, for example, what diagnosis they suspect and how likely it is that the patient actually has that problem. In addition, if a medical resident orders the test, an attending physician has to approve.

The study found that use of the tool reduced CT scans by 10 percent. Because there was no corresponding increase in the number of patients who were admitted to the hospital, which commonly happens if a diagnosis remains elusive, the study presumed that the eliminated scans would have been unnecessary.

One author of the study told HealthImaging that the questions involve four screens and that it takes less than 20 seconds to click through the screens.

Abdominal pain is the most common complaint in U.S. emergency departments, accounting for 10 million visits each year, according to a Penn Medicine news release. A wide variety of problems, from minor to life-threatening, can cause such pain. Doctors often order CT scans to sort out the diagnosis. But there are no clear guidelines as to when CT use is indicated, and the scans expose patients to ionizing radiation.

“Most patients with abdominal pain aren’t in major danger, but some of the conditions that are on the list of things we consider as causes can be fatal within a short amount of time,” said Angela M. Mills, MD, an assistant professor of emergency medicine and medical director of the emergency department at the Hospital of the University of Pennsylvania. She added:

We need to be sure about our diagnosis in order to keep patients safe, but we need to balance the risks of giving a test like a CT scan with the chance that the test will truly provide us with information we could not get in some other way with less risk to the patient.

Dr. Mills was an author of the study, which was presented last week at the annual meeting of the Society for Academic Emergency Medicine in Chicago.

The study involved 11,176 patients seen in two Penn Medicine emergency rooms from July 2011 through March 2012. Before implementation of the new “accountability tool,” 32.3 percent of the patients received CT scans. After the tool was adopted, the percentage dropped to 28. After adjusting for various confounding factors, researchers determined that the usage of CT scans for abdominal patients decreased by 10 percent.

An enhanced version of the tool, adopted after  the study was completed, provides information about how many abdominal imaging tests the patient has previously undergone at Penn and totals the patient’s radiation exposure from previous CT scans.

“For many patients, like those who are older or have cancer, this tool might not make a difference,” Dr. Mills said, “but there are many abdominal patients who are younger, healthier, and who have things that are usually not life-threatening, like kidney stones, for whom we are hoping this will reduce their exposure to unnecessary radiation.”

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Prolonged exposure to mildly elevated radiation doses may be no big deal. Find out more on our Facebook page.

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

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