Evaluation of Acute Abdominal Pain in the Emergency Setting Using Computed Tomography Without Oral Contrast in Patients With Body Mass Index Greater Than 25.

Purpose: To evaluate the rate of delayed or missed diagnoses and need for additional computed tomography (CT) imaging in emergency department patients with abdominal pain who are imaged without oral contrast.

Materials And Methods: The institutional review board approved this Health Insurance Portability and Accountability Act-compliant retrospective study; informed consent was waived. All consecutive adult patients with body mass index greater than 25 undergoing a CT abdomen/pelvis with intravenous contrast and without oral contrast with nontraumatic acute abdominal pain during a 16-month period at our academic tertiary care center were included. Medical records were reviewed, imaging findings on admission CT, use of repeat CT examinations within 4 weeks of the original examination, and clinical outcomes were recorded. In patients undergoing repeat imaging, an investigator determined whether repeat imaging was influenced by the lack of oral contrast on the original examination. As the most common cause of bowel-related positive CT scans, an analysis of acute appendicitis was performed.

Results: Of the 1992 patients included in this study, 4 patients (0.2%) underwent repeat CT studies directly related to the absence of oral contrast on the original examination. Of the 1992 CT scans, 1193(59.8%) were interpreted as negative, none of which required surgery or direct intervention. In patients with acute appendicitis, there was a sensitivity of CT in this patient population of 100% with a specificity of 99.5%.

Conclusions: In patients with body mass index greater than 25 presenting to the ED with acute abdominal pain, CT examinations can be acquired without oral contrast without compromising the clinical efficacy of CT.