Purpose
The plain film has an increasingly limited role in the assessment of patients presenting with non-traumatic abdominal pain (1).
Its use,
purely anecdotally,
appears to be more in determining appropriateness for discharge of patients in the acute setting.
It is often used defensively in medicine or to buy time.
The aim of this study was to determine the appropriateness and subsequently the value of this high-dose and low positive and negative predictive value investigation,
with an aim to producing a streamlined list of indications,
through...
Methods and Materials
This was a retrospective study of a one-month sample of abdominal plain films,
performed and reported in a large tertiary referral centre.
Abdominal films of all non-traumatic cases excluding patients under the age of 16 were audited.
Children were excluded as pathologies vary from those of adults and therefore pathways of investigations.
All reports included in the study were verified by a senior registrar or consultant radiologist.
A comprehensive investigation of the 304 films and the clinical request cards included the following:
Gender,
Age,
Clinical...
Results
Over the one-month period,
304 plain abdominal x-rays were carried out in total.
The justification for each exam was based upon the clinical questions stated by the referrer on the request card.
No patient in this study was exposed without adequate justification being provided at the time of request.
However when assessing,
for the purposes of the audit,
the appropriateness of each investigation the wider clinical history provided by the clinicians was taken into consideration. This information was then related to the RCR guidelines (2)....
Conclusion
It would seem that despite a great many literature reviews and audits of practice,
no studies have been translated into revised recommendations by the Royal College of Radiologists for use of the abdominal plain film.
The current guidelines have little evidence base or basis from established practice.
In 2011 a multicentre prospective trial of patients in the Netherlands concluded that plain radiographs should be omitted from the routine diagnostic work up of patients with acute abdominal pain to a substantial cost saving effect (5).
It...
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Kahnzada TW,
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Abuse of plain abdominal radiographs in abdominal pain.
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