Carly Susan Gardner MD, Presenter: Nothing to Disclose

Tracy Anne Jaffe MD, Abstract Co-Author: Nothing to Disclose

Rendon C. Nelson MD, Abstract Co-Author: Consultant, General Electric Company Consultant, Nemoto Kyorindo Co, Ltd Consultant, VoxelMetrix, LLC Research support, Bracco Group Research support, Becton, Dickinson and Company Speakers Bureau, Siemens AG Royalties, Wolters Kluwer nv

To evaluate the diagnostic yield of abdominopelvic computed tomography (CT) in geriatric patients presenting to the Emergency Department (ED) with acute abdominal pain and effect on management.

Medical records search from 1/2004-1/2013 identified 327 geriatric patients (> 80 yo; 248 women, 79 men) undergoing abdominopelvic CT in the ED for acute abdominal pain. Cases were reviewed for study indication and pre-CT vs. post-CT diagnoses. Report interpretations were categorized into with and without acute findings. Those with acute results were subdivided into medical and surgical diagnoses. Analysis of ED records was performed to determine whether results of the CT changed management, including medication treatment changes, referrals to a subspecialty, surgical operations and minimally invasive procedures. Anticipated admission status prior to imaging, actual disposition from the ED, and final disposition of those admitted were also recorded.

Of the 327 geriatric patients undergoing CT in the ED for acute abdominal pain, the most common indications for CT were small bowel obstruction (SBO) (66/327, 20%), abdominal aortic aneurysm rupture or dissection (40/327, 12%), diverticulitis (37/327, 9%), and bowel ischemia or perforation (30/327, 9%). Most common CT diagnoses were gastrointestinal ischemia (28/249, 11%), diverticulitis/colitis (23/249, 9%) and SBO (22/249, 9%). Of all patients, 214 (65%) required hospital admission, of which results of CT determined admission in 144 patients (67%). 249 of 327 patients (77%) had acute or treatable positive findings on CT (119 medical, 130 surgical). CT changed management in 92 patients (37%); 10 medically and 82 surgically. Patients with surgical issues (82/130, 62%) were treated operatively (41/82, 50%) or with minimally invasive operations/procedures (41/82, 50%).

Radiology interpretations from abdominopelvic CTs obtained in the ED have an impact on geriatric patient management, influencing primarily surgical rather than medical issues and subsequent treatment.

The utilization of CT in the geriatric patient population will be an increasingly important issue for future health care management and cost.

Gardner, C, Jaffe, T, Nelson, R, Impact of CT on Geriatric Patients Presenting to the Emergency Department with Acute Abdominal Pain.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011995.html