Appropriateness of Chest-Abdominal-Pelvis Computed Tomography Use in the Emergency Department
2Department of Radiology, Hadassah Hebrew University Medical Center, Israel
3Emergency department, Hadassah Hebrew University Medical Center, Israel
Background & Aims: We assessed the appropriateness of Chest-Abdominal-Pelvis (CAP) Computed Tomography (CT) scan use in the Emergency Department (ED), based on expert physicians and the ESR-Iguide, a clinical decision support tool (CDSS).
Methods: We included 100 consecutive cases of CAP CT scans ordered at the ED in a tertiary hospital in 2020. Four experts (two radiologists and two emergency medicine physicians (EM)) rated the appropriateness of the use of CAP CT on a 7-point scale. The ESR-iGuide score recommendation for the CT CAP protocol was used to evaluate the appropriateness of the ED decision.
Results: The mean rating of the four experts was 5.2 ± 0.106, (Median-5.5). Based on the mean rate, the experts considered only 63% of the tests as appropriate (using a threshold of 5). Using a three-class variable (1-2; 3-5; 6-7), the Overall Percentage Agreement between the experts was 46.5%. Agreement was higher among EM (51%) experts than among radiologists (44%). According to the ESR iGuide system, for a high proportion of the cases (85%;n=85), CAP CT use was inappropriate, while if imaging of the chest was omitted then the Abdominal-Pelvic protocol was recommended for 65 out of those 85 cases. The Pearson Correlation coefficient between the average expert rating and ESR-scores was 0.09 (p>.05) for the CAP protocol and 0.22 for the Abdominal-Pelvic protocol (p=0.029).
Conclusions: According to both the experts and the ESR-Iguide, inappropriate testing was prevalent. The findings raise the need for unified workflows that might be achieved using a CDSS tool.