Premium
Appropriateness of adult plain abdominal radiograph requesting in a regional Emergency Department
Author(s) -
Fernandez Michelle,
Craig Simon
Publication year - 2019
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12847
Subject(s) - medicine , emergency department , plain radiography , emergency medicine , general surgery , radiology , medical emergency , radiography , psychiatry
Although commonly ordered, abdominal x‐rays are thought to be overused and unhelpful in many emergency department patients. Our objectives were to evaluate the appropriateness of plain abdominal X‐ray (AXR) requests in adult patients presenting to a Victorian regional emergency department (ED). Methods A retrospective chart review was performed of all adult patients with a plain AXR requested by ED medical staff members in a regional healthcare centre in Victoria, Australia in 2016. Patient demographics, ED disposition and any further imaging results were extracted from the medical record. Indications for X‐ray and clinician seniority were determined from the radiology request slips signed by the treating emergency doctor. Appropriateness of imaging was determined by comparing the indication for abdominal radiograph to local evidence‐based guidelines. Results One hundred and nine episodes of plain AXR requests met the inclusion criteria. Of these, 40 were considered inappropriate according to clinical guidelines. Overall, 36% (39/109) had normal or non‐specific findings and 42% (46/109) demonstrated faecal loading, while 22% (24/109) identified pathology. Thirty‐three patients had further imaging, mostly with computed tomography ( CT ). Junior staff members were responsible for most of the AXR requests. Conclusion In our regional hospital ED , over one third of AXR s requested for adult patients were inappropriate according to clinical guidelines. AXR s have a low diagnostic yield and frequently do not reduce the need for further imaging. The use of a clinical practice guideline and education of junior medical staff may increase the appropriate use of plain AXRs in the regional ED setting.