In this study, CT was used to alter the leading diagnosis in 49% of the patients and increase mean physician diagnostic certainty from 70.5% (pre-CT) to 92.2% (post-CT). The management plan was changed by CT in 42% of the patients. In another study of 522 young adult patients presenting to the ED with abdominal pain, no laboratory test was sufficient to offer reassurance that a CT was not necessary [72]. One retrospective study evaluating 333 ED patients with acute abdominal pain and an abdominal CT demonstrated no significant difference in accuracy if the radiologist was blinded to relevant clinical or laboratory information (approximately 85%) [73]. CT is highly accurate in determining the site of visceral perforation, particularly in the setting of upper intestinal perforation, which could impact the surgical approach [74]. With an aging United States population and the relatively high frequency of ED presentations for acute abdominal pain, multiple recent studies have looked at the imaging evaluation of elderly patients, particularly the range of diagnoses and the use of abdominal CT. Depending on the article, elderly is defined as ranging from >65 years of age to >80 years of age. In this subset of the population, many laboratory tests are nonspecific and may be normal despite serious abnormalities [4-6]. Many authors advocate for liberal use of CT in elderly patients [4,75,76]. The most common causes of abdominal pain in elderly patients undergoing a CT examination are different than those in younger patients. One retrospective study looked at the use of CT in 464 patients >80 years of age and found the most common diagnoses were SBO (18%), diverticulitis (9%), nonischemic vascular emergencies including abdominal aortic aneurysm and dissection (6%), bowel ischemia (4%), appendicitis (3%), and colonic obstruction (2%). These diagnoses were clinically unsuspected in 43% of patients [4].
Acute Nonlocalized Abdominal Pain. In this study, CT was used to alter the leading diagnosis in 49% of the patients and increase mean physician diagnostic certainty from 70.5% (pre-CT) to 92.2% (post-CT). The management plan was changed by CT in 42% of the patients. In another study of 522 young adult patients presenting to the ED with abdominal pain, no laboratory test was sufficient to offer reassurance that a CT was not necessary [72]. One retrospective study evaluating 333 ED patients with acute abdominal pain and an abdominal CT demonstrated no significant difference in accuracy if the radiologist was blinded to relevant clinical or laboratory information (approximately 85%) [73]. CT is highly accurate in determining the site of visceral perforation, particularly in the setting of upper intestinal perforation, which could impact the surgical approach [74]. With an aging United States population and the relatively high frequency of ED presentations for acute abdominal pain, multiple recent studies have looked at the imaging evaluation of elderly patients, particularly the range of diagnoses and the use of abdominal CT. Depending on the article, elderly is defined as ranging from >65 years of age to >80 years of age. In this subset of the population, many laboratory tests are nonspecific and may be normal despite serious abnormalities [4-6]. Many authors advocate for liberal use of CT in elderly patients [4,75,76]. The most common causes of abdominal pain in elderly patients undergoing a CT examination are different than those in younger patients. One retrospective study looked at the use of CT in 464 patients >80 years of age and found the most common diagnoses were SBO (18%), diverticulitis (9%), nonischemic vascular emergencies including abdominal aortic aneurysm and dissection (6%), bowel ischemia (4%), appendicitis (3%), and colonic obstruction (2%). These diagnoses were clinically unsuspected in 43% of patients [4].