ED Physicians Feel Better About Diagnosis When CT Involved

When CT is available in the emergency room, physicians are more confident about their patient care decisions.

Physicians in the emergency department are more certain about diagnoses and changed admission decisions when CT is used, according to a study published in Radiology.

Researchers from Massachusetts, Washington, and North Carolina performed a prospective study to determine how physicians’ diagnoses, diagnostic uncertainty, and management decisions are affected by the results of CT in emergency department settings.

Data from patients at four centers who presented to the ED with complaints of abdominal pain, chest pain and/or dyspnea, or headache and who were referred for CT were collected between July 12, 2012 and January 13, 2014. Results were available for 1,280 patients and 245 physicians.

The researchers surveyed the attending physicians before and after CT. The physicians were asked about:[[{"type":"media","view_mode":"media_crop","fid":"42913","attributes":{"alt":"emergency radiology","class":"media-image media-image-right","id":"media_crop_629173832706","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4669","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 113px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Condor 36/Shutterstock.com","typeof":"foaf:Image"}}]]

Leading diagnosis

Diagnostic confidence (on a scale of 0% to 100%)

Alternative “rule out” diagnosis

Management decisions

The primary measures were the proportion of patients for whom the leading diagnosis or admission decision changed and median changes in diagnostic confidence, and the secondary measures addressed alternative diagnoses and return-to-care visits at one-month follow-up.

The leading diagnosis was changed for many patients following the CT scan:

 Number of patients
Abdominal pain235 of 460 patients (51%)
Chest pain and/or dyspnea163 of 387 (42%)
Headache103 of 433 (24%)

“Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change,” the authors wrote. “Median changes in confidence were substantial (increases of 25 percent, 20 percent, and 13 percent, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache; P < .0001); median post-CT confidence was high (95 percent for all three groups). CT helped confirm or exclude at least 95 percent of alternative diagnoses.”

CT images resulted in changes of several admission decisions:

 Number of patients
Abdominal pain116 of 457 patients (25%)
Chest pain and/or dyspnea72 of 387 (19%)
Headache81 of 426 (19%)





During the one-month follow-up, there were return visits from patients who returned for the same complaints:

 Number of patients
Abdominal pain70 of 450 patients (15%)
Chest pain and/or dyspnea53 of 387 (14%)
Headache49 of 433 (11%)





The researchers concluded that the physicians’ diagnosis and admission decisions were frequently affected by results from CT, and diagnostic uncertainty was alleviated.