ACR Appropriateness Criteria® Acute (Nonlocalized) Abdominal Pain and Fever or Suspected Abdominal Abscess EVIDENCE TABLE Reference 1.

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Study Type

Patients/ Events N/A

Study Objective (Purpose of Study) Review data on cost effectiveness and diagnostic accuracy of unenhanced helical CT in acute abdominal pain. Prospective observational study to: 1) determine if older patients with abdominal pain who receive emergency department abdominal CT have changes in diagnosis and/or disposition more often than similar patients without CT; 2) compare physician confidence in diagnosis and disposition for patients with vs without CT; and 3) document factors that most influence physician's decision to order abdominal CT in this population.

Mindelzun RE, Jeffrey RB. Unenhanced helical CT for evaluating acute abdominal pain: a little more cost, a lot more information. Radiology 1997; 205(1):4345. Lewis LM, Klippel AP, Bavolek RA, Ross LM, Scherer TM, Banet GA. Quantifying the usefulness of CT in evaluating seniors with abdominal pain. Eur J Radiol 2007; 61(2):290-296.

Review/OtherDx

ObservationalDx

126 patients

Yeh EL, McNamara RM. Abdominal pain. Clin Geriatr Med 2007; 23(2):255270, v.

Review/OtherDx

N/A

* See Last Page for Key

To review abdominal pain in the elderly, discuss the clinical approach, and highlight key diagnostic considerations.

2012 Review

Study Results Helical CT provides clinically relevant information at a reasonable cost.

Abdominal CT rate was 59% (95% CI, 50%67%). CT was associated with an increased change in diagnosis (46%; 95%CI, 4%-58% vs 29%; 95% CI, 16%-42%), but no change in disposition between patients with vs without CT. Preliminary diagnostic confidence was lower for emergency physicians who ordered a CT than for those who did not (P