eP72 Assessing the Utility of Abdominal X-Rays in Emergency Settings: Are They Adding Value?
Ashling Ramdin, Christopher Smith, Harry Middleton, Michail ChatzikonstantinouAbstract
Background
The clinical value of abdominal X-rays (AXRs) in emergency departments (EDs) is debated, particularly with the availability of advanced imaging modalities like ultrasound (US) and computed tomography (CT). Despite the 2016 Royal College of Radiologists (RCR) guidelines limiting AXR use to specific indications, concerns about their overuse persist.
Methods
A retrospective observational study was conducted from January 1st to March 31st, 2023, in a London district general hospital. We evaluated 473 patients who underwent AXRs, examining compliance with RCR guidelines, clinical indications, AXR findings, follow-up imaging, and referrals to General Surgery. Pearson’s chi-squared test was used for statistical analysis, with significance set at p < 0.05.
Results
81.6% of AXRs met RCR guidelines, primarily for suspected bowel obstruction; however, only 11.4% of patients had all three key symptoms (abdominal pain, vomiting, failure to open bowels). Follow-up imaging was performed in 37.6% of cases, mainly CT scans. Abnormal findings were noted in 15% of AXRs, but 63.4% of these required additional imaging. Significant associations were found between abnormal AXRs and General Surgery referrals, as well as between referrals and subsequent CT scans.
Conclusions
AXRs are frequently overused in the ED, with limited diagnostic value. Even when AXRs identify abnormalities, CT follow-up is often required, suggesting AXRs may not significantly alter management. Reconsidering the role of AXRs in ED practice and promoting advanced imaging modalities could enhance diagnostic efficiency and reduce unnecessary resource use.