Canadian Association of Radiologists Journal xx (2015) 1e5 www.carjonline.org

Trauma and Emergency Room Imaging / L’imagerie des urgences et des traumatismes

Is Oral Contrast Necessary for Multidetector Computed Tomography Imaging of Patients With Acute Abdominal Pain? Abdullah Alabousi, MDa, Michael N. Patlas, MD, FRCPCa,*, Niv Sne, MD, FRCSCb, Douglas S. Katz, MD, FACR, FASERc a

Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada b Department of Surgery, McMaster University, Hamilton, Ontario, Canada c Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA

Abstract Purpose: The purpose of our study was to validate the hypothesis that eliminating the use of oral contrast for multidetector computed tomography (MDCT) would not affect the detection of acute abdominal abnormalities in emergency room patients. Methods: We conducted a retrospective study to assess the effect of discontinuing oral contrast use for MDCT scans of the abdomen and pelvis for patients presenting with acute abdominal pain and body mass index (BMI) >25. Patients with BMI 25 presenting with acute abdominal pain resulted in no delayed or missed diagnoses, in our retrospective study. The benefits of prompt imaging diagnosis outweigh the unlikely need for repeat imaging. Resume Objectif : Valider l’hypothese selon laquelle l’elimination du recours a un produit de contraste administre par voie orale lors d’une tomodensitometrie multibarrettes (TDM multibarrettes) ne nuirait pas a la detection d’une anomalie abdominale aigu€e chez les patients admis au service d’urgence. Methodes : Une etude retrospective a ete realisee afin d’evaluer l’effet de l’elimination du produit de contraste administre par voie orale en vue d’une TDM multibarrettes de l’abdomen et du bassin chez les patients qui se presentaient au service d’urgence avec une douleur abdominale aigu€e et dont l’indice de masse corporelle etait superieur (IMC) a 25. Un produit de contraste a ete administre par voie orale a ceux dont l’IMC etait inferieur a 25. Les dossiers medicaux ont ete examines pour determiner le taux d’examens d’imagerie de reprise dans les sept jours suivant la TDM initiale, ainsi que le taux de diagnostics retardes ou errones en raison de l’absence de produit de contraste administre par voie orale. L’etude a ete approuvee par le comite d’ethique de la recherche de l’etablissement. Resultats : Au total, 1 378 patients ont subi une TDM multibarrettes de l’abdomen et du bassin entre le 1er novembre 2012 et le 31 octobre 2013. De ce nombre, 375 repondaient aux criteres d’inclusion (174 hommes et 201 femmes de 18 a 97 ans, avec un ^age moyen de 57 ans). Sept des 375 patients (1,9 %) ont subi une TDM de reprise avec produit de contraste administre par voie orale dans les sept jours suivant la TDM initiale. Le recours au produit de contraste administre par voie orale n’a pas eu pour effet de modifier la prise en charge chez aucun de ces sept patients. Par ailleurs, il n’y a eu aucun diagnostic retarde ou errone en l’absence de produit de contraste administre par voie orale. Conclusion : L’omission du produit de contraste administre par voie orale chez les patients dont l’IMC est superieur a 25 et qui doivent subir un examen d’imagerie en raison d’une douleur abdominale aigu€e n’a pas entra^ıne de retard ou d’erreur de diagnostic dans le cadre de la

* Address correspondence to: Michael N. Patlas, MD, FRCPC, Division of Emergency/Trauma Radiology, Department of Radiology, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.

E-mail address: [email protected] (M. N. Patlas).

0846-5371/$ - see front matter Ó 2015 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2015.03.003

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A. Alabousi et al. / Canadian Association of Radiologists Journal xx (2015) 1e5

presente etude retrospective. Les avantages d’un diagnostic par imagerie rapide surpassent le risque improbable d’examen de reprise. Ó 2015 Canadian Association of Radiologists. All rights reserved. Key Words: Abdominal pain; Multidetector computed tomography; Oral contrast

Multidetector computed tomography (MDCT) imaging of the abdomen and pelvis is the imaging examination of choice for evaluating patients presenting with abdominal pain. CT has been proven to be highly sensitive and specific for numerous gastrointestinal, urologic and other conditions [1]. In addition, CT has been shown to accurately depict or allow the exclusion of significant pathology, including those requiring surgical interventions [2]. This is especially true in the emergency department (ED), where MDCT imaging is of vital importance in the triage and management of acutely ill patients [3,4]. Given the continued rise in the utilization of MDCT in ED [3] and the potential grave consequences of a delayed diagnosis, optimizing the protocol for MDCT of the abdomen and pelvis for those patients is of utmost importance. Given that patients who presented to the ED with acute abdominal pain have been found to spend disproportionately more time before disposition than other groups of ED patients [5], it is imperative to minimize any potential delays in obtaining the CT examinations in such patients. Multiple CT protocols are currently used at different institutions, which include the use of IV, oral and rectal contrast agents either alone or in combination [6]. One technique that contributes to the delay in obtaining MDCT examinations of the abdomen and pelvis is the use of oral contrast. To our knowledge, the use of oral contrast for acute abdominal pain assessment on MDCT examinations has not been sufficiently studied, despite its long-standing and widespread use. In the early days of CT, oral contrast was used to help delineate soft-tissue planes between intraperitoneal structures [1]. Specifically, oral contrast was found to be helpful in differentiation of various segments of the duodenum from the pancreas, small bowel from mesenteric lesions and occasionally helping differentiate intraperitoneal lesions from retroperitoneal ones [1]. However, the introduction of MDCT (and helical CT prior to that) has made the usefulness of oral contrast uncertain [1]. Several studies have demonstrated that CT examinations without the use of oral contrast are accurate for the diagnosis of acute appendicitis [7e10]. We therefore conducted a retrospective evaluation in order to assess the effect of eliminating oral contrast use for MDCT scans of the abdomen and pelvis in patients presenting with non-traumatic undifferentiated acute abdominal pain. The purpose of our study was to validate the hypothesis that our change in clinical practice of discontinuing the use of oral contrast in such examinations did not significantly affect the detection of acute abnormalities in the emergency setting. Methods Our study was approved by the research ethics board at our institution. Informed consent was waived.

The use of oral contrast for ED patients requiring a CT scan of the abdomen and pelvis at our institution, an urban tertiary care centre, was discontinued as of November 1, 2012. Patients with a body mass index (BMI)

Is Oral Contrast Necessary for Multidetector Computed Tomography Imaging of Patients With Acute Abdominal Pain?

The purpose of our study was to validate the hypothesis that eliminating the use of oral contrast for multidetector computed tomography (MDCT) would n...
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