Non-Contrast CT: An Effective Option for Evaluating Acute Abdominal Pain

Non-contrast CT (NCCT) may be an effective option for evaluating nontraumatic abdominal pain in the emergency setting, according to a study published in the Journal of Emergency Medicine.¹

Austin Payor, DO, from the department of emergency medicine at the University of South Florida, Tampa, and colleagues enrolled 72 ED patients undergoing NCCT of the abdomen and pelvis for acute nontraumatic abdominal pain. Follow-up timepoints of 1, 3, and 7 days were selected on the premise that any missed emergent acute pathology would continue to progress and worsen, leading to a repeat CT with contrast or abdominal surgery that would reveal the true etiology of the condition.

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Exclusion criteria included a history of abdominal or pelvic trauma or surgery within 30 days; suspicion of renal stone or an unstable condition; and a history of abdominal or pelvic primary or metastatic cancer.

Results showed that 39 patients (54%) had a positive NCCT; of 41 admitted to the hospital, 8 underwent abdominal surgery. Only 3 of the patients required a contrast CT within the 7-day period, and the findings — a pelvic mass, colitis, and pancreatitis — were identified on both the NCCT and contrast CT exams.

“The practicing physician remains always cognizant of the ever-looming threat of legal action as they try to provide care to the patient…For the busy emergency physician, the ideal test is not one that would provide the diagnosis every time, but one that would guarantee that no disease process is missed when disease is present,” the authors write.

Though the study was limited by sample size, the authors concluded that, “With our given inclusion and exclusion criteria, noncontrast CT of the abdomen and pelvis is likely a reliable diagnostic modality for nontraumatic abdominal pain in the ED. We hope additional studies are conducted to validate our findings.”