Should plain radiographs persist or be replaced by alternative scans for imaging of acute painful non-traumatic abdominal pain?

Purpose: Acute non-traumatic abdominal pain (ANTAP) is a frequent presentation at the emergency department (ED). Plain abdominal radiographs (PAR's) were historically the principal imaging tool. The objective of this study was to determine whether PAR's are still in use for ANTAP diagnosis. The other objective was to determine whether PAR’s stood-alone or were they a redundant step delaying the definitive imaging test. When CT scans were added to PAR's, the sensitivity and specificity of the two modalities were compared. Methods: A report of a retrospective study conducted at an 800-bed hospital ED between 01.06.2014 and 30.06.2014. All patients aged 15 and above who presented with ANTAP and referred first for PAR’s were included. Traumatic, obstetric, gynaecologic cases were excluded. The discharge diagnosis was considered the gold standard. Main findings: The study included 756 patients. 375 (49.6%) were males, 381 (50.4%) were females. The age range was 15 to 92 yrs. Mean age was 46 yrs. The most common presentation was an unclassified abdominal pain in 516 (68%). PAR's were requested alone for 594 (78.5%) and in combination with Conventional CT in 103 (13.6%). Low dose CT was added for 33 (4.3%). The sensitivity of PAR's and CT for urinary stones was 32.8% and 91.3% respectively. The sensitivity of PAR's and CT for intestinal obstruction was 50% and 83.3% respectively. Conclusion: PAR's are still in use as a one-stop shop for imaging the majority of patients presenting with ANTAP. In patients who had both CT and PAR's, there was a low PAR's sensitivity leading to poor congruence in diagnosing abnormal cases. However, CT delivered a higher radiation dose. There is a need to replace the conventional CT and PAR's for ANTAP imaging.