Adherence to Diagnostic Imaging Pathways for Patients Presenting to Emergency Departments With Undifferentiated Acute Abdominal Pain: Impact on Radiation Exposure and Multiple Imaging Testing.

Abstract

Introduction: The Diagnostic Imaging Pathways (DIP) are a tool that has been developed to assist physicians with selecting appropriate imaging tests. Adherence to these imaging pathways and their impact on patient outcomes have not been explored. This study aims to assess the impact that adherence to the acute abdomen DIPs has on the number of imaging tests performed and patients' exposure to imaging modalities that utilise radiation.

Method: Imaging requests and radiologist's reports of 1257 patients who presented to emergency departments with abdominal pain and had abdominopelvic computed tomography (CT) scans were collected over a period of 1 year. These data were classified into whether or not patients' imaging investigations followed the DIPs for undifferentiated acute abdominal pain. Based on this classification, we assessed the impact that adherence to the DIP had on diagnostic yield, patients' exposure to imaging tests that utilise radiation, and the number of diagnostic imaging tests performed.

Discussion: The results highlight poor adherence to DIPs with 71% of acute abdomen presentations not following the recommended pathways. While the proportion of pathologies detected when DIPs were followed compared to when DIPs were not followed was similar, there were significant reductions in the number of imaging tests performed and radiation dose burden to patients. Given the risks associated with radiation exposure and the need to optimise health resources, these results suggest that the DIPs are a useful tool for optimising radiation dose and cost in patients presenting with abdominal pain.

Conclusions: Adherence to imaging guidelines shows a strong positive correlation in reducing patient exposure to radiation and multiple imaging.