Utilization of abdominal radiography in the emergency department: Appropriateness, interpretation, radiation protection and costs.

INTRODUCTION: The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital. MATERIAL AND METHODS: We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient's demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs. RESULTS: In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, n = 176), followed by low back pain (21.4%, n = 92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (n = 263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50 ±â€¯0.33 mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (p < 0.001). Only 3% of the AXR had a formal radiology report. CONCLUSIONS: AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.

Rentabilidad de la tomografía axial computarizada en el diagnóstico de la fiebre de origen desconocido clásica / Cost-effectiveness of computerized axial tomography in the diagnosis of traditional clinical picture of fever of unknown origin

La estrategia diagnóstica en la fiebre de origen desconocido ha ido cambiando en las últimas décadas. El objetivo de este estudio es consolidarla tomografía axial computarizada toraco- abdominal en la primera etapa diagnóstica. Se obtuvo una muestra de 24 pacientes con fiebre de origen desconocido clásica seleccionados en el Servicio de Medicina Interna de nuestro hospital entre enero de1995 y diciembre de 2002. Se estudió la rentabilidad diagnóstica de la tomografía axialcomputarizada toracoabdominal frente ala ecografía abdominal, y la información que ambas proporcionaban para el diagnóstico final. La tomografía aportó datos sugestivos del diagnóstico en 10 de 24 pacientes (41,7%); la ecografía abdominal sólo dio información orientadora al diagnóstico en dos casos (8%). De los 10 pacientes con alteraciones específicas en la tomografía axial computarizada, se llegó a un diagnóstico definitivo concluyente (con análisis de muestra biológica) en9 de ellos (90%). Por tanto, está justificado el uso de esta técnica al inicio del estudio de la fiebre de origen desconocido clásica para orientar al clínico a recurrir de forma dirigida a otras técnicas más específicas y con mayor rentabilidad diagnóstica

Diagnostic strategy in fever of unknown origin hasbeen changing in recent decades. The objective of this study is to define the role of thoracoabdominal computerized axial tomography in the first diagnostic stage. A sample of 24 patients with classical fever of unknown origin from our hospital Internal Medicine department was selected between January 1995 and December 2002. Cost effectiveness of diagnostic thoracoabdominal computerized axial tomography compared to that of abdominal echography was analyzed; the information obtained with both diagnostic techniques for the final diagnosis was also evaluated. Computerized axial tomography contributed data suggestive of the diagnosis in10 of 24 patients (41.7%); abdominal echography only gave orienting information to the diagnosis in 2 cases (8%). In 9 (90%) of the 10 patients with computerized axial tomography specific alterations, a conclusive definitive diagnosis (with analysis of biological sample) was possible. Accordingly, the use of this technique is justified at the beginning of the study of the classical fever unknown origin in order to orient the clinician to resort to other more directed and specific diagnostic techniques and with higher diagnostic cost-effectiveness