“CT scans are popular because they don’t miss anything,” Dr. Goldstein said, explaining that patient follow-ups are ideal yet impractical in the typical ED setting. If you could implement 1-day, 3-day, and 7-day follow-ups [as done in the study], that would be great, but it’s hard to implement, both time-wise, and from a personnel standpoint.”
The small study size also created some limitations in extrapolating the results to the larger patient population. “It is a fairly small sample size that they have when you look at the diseases that have been diagnosed in the study — they were in the single digits for each,” Dr. Sierzenski noted.
“In abdominal pain, you’re looking at patient populations in the tens of millions, and here, you’re looking at a study that enrolled roughly 70 patients — so I think that you really have to wonder about the translatability of that. I think the authors were appropriate in saying that this represents…an intro where further studies are indicated,” Dr. Sierzenski explained.
Despite the limitations conferred by inclusion and exclusion criteria and study size, the study does have some merits. “This wasn’t an industry-supported study,” Dr. Sierzenski pointed out. “It was a homegrown study, so there are some significant biases that are removed.”
- Efficacy of noncontrast computed tomography of the abdomen and pelvis for evaluating nontraumatic acute abdominal pain in the emergency department. J Emerg Med. 2015 Aug 22. pii: S0736-4679(15)00684-8. doi: 10.1016/j.jemermed.2015.06.062. [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/26306680.
- Low-dose abdominal CT for evaluating appendicitis. N Engl J Med 2012; 366:1596-1605. April 26, 2012.DOI: 10.1056/NEJMoa1110734. http://www.nejm.org/doi/full/10.1056/NEJMoa1110734.