Impact of Eliminating Oral Contrast on Computed Tomography Abdomen/Pelvis Throughput in the Pediatric Emergency Setting: A Multisite Analysis.

Abstract

Objective: Historically, oral contrast has been considered essential for the evaluation of abdominal pathology on computed tomography (CT). With advances in CT technology, the need for oral contrast has decreased. Many pediatric studies have shown that lack of oral contrast has no impact on the diagnostic accuracy of CT abdomen/pelvis for evaluation of acute abdominal pain. This study evaluates the impact of updated oral contrast guidelines on patient throughput in a large multisite children's health care system.

Methods: This is a single pediatric health care system multisite retrospective study. Guidelines for abdominopelvic CT scans from pediatric emergency departments at 2 free-standing children's hospitals were modified to limit the use of oral contrast in 2021. Interrupted time series analysis was performed, evaluating the use of oral contrast before and after targeted intervention during 2019 and 2023, and the impact of guidelines on turnaround time for performance of CT examinations.

Results: A total of 2259 abdominopelvic CT examinations from the emergency department (ED) were evaluated, 48.7% (1101/2259) before intervention and 51.3% (1158/2259) following intervention. Sex was similar during the 2 periods [females: 47.6% (524/1101) and 48.9% (566/1158) respectively; P = 0.54]. Median (IQR) age was 10 years old (7 to 14) and 12 years old (7 to 15) in 2019 and 2023, respectively (P = 0.001). Before intervention, oral contrast was used in 32.7% (278/851) examinations at hospital 1 and 41.6% (104/250) examinations at hospital 2. Following intervention, oral contrast use decreased at hospital 1 to 5.4% (45/835) and at hospital 2 to 2.5% (8/323) (all P < 0.001). After intervention, mean time from CT order to examination completion at hospital 1 changed from 129 to 100 minutes (P < 0.001) and at hospital 2 changed from 152 to 76 minutes(P < 0.001).

Conclusion: Changes to oral contrast guidelines successfully decreased the use of oral contrast in abdominopelvic CT scans from the pediatric ED, resulting in significantly improved examination throughput.