ABSTRACT NUMBER: NESTAC_14
Wadah Ali, A Suliman, Stephanie Smith, M Jha
James Cook University Hospital
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MAIN ABSTRACT TEXT
Abdominal X-rays (AXR) are a routinely requested investigation in the emergency department. There is a common tendency to arrange abdominal x rays in “to complete the work up” of patients presenting with abdominal pain. This results in undue radiation exposure and pressure on resources. The average cost of one abdominal X-ray to the department is 98£ (Hospital cost 50£+Radiologist cost 48£).
To review our practice and adherence to guidelines when requesting AXR; namely The Royal college of Radiologists (RCR) iRefer guidelines for requesting an abdominal radiograph, which are;
- Clinical suspicion of obstruction
- Acute exacerbation of inflammatory bowel disease
- Palpable mass (specific circumstances)
- Constipation (specific circumstances)
- Acute and chronic pancreatitis (specific circumstances)
- Sharp/poisonous foreign body
- Smooth and small foreign body, e.g., coin, battery (specific circumstances)
- Blunt or stab abdominal injury (specific circumstances)
Retrospective review of notes, radiology requests and images of 50 patients referred from the accident and emergency to the surgical department at James Cook University Hospital with abdominal pain who underwent a plain abdominal radiograph
We found that only 50% of requests complied with the guidelines, adding to a total unnecessary cost of 2450£. Only 38% of request cards had adequate clinical history. Abdominal X ray often did not lead to a diagnosis or alter management and often further investigations were needed.
Abdominal X rays are often mistakenly requested as a standard assessment tool for acute abdominal pain but they add very little to the clinical picture. This adds a significant burden or resources and delays management. Moreover, there is a significant radiation exposure involved. We plan to re audit after conducting sessions and distributing posters in the A&E and surgical departments to raise awareness and introduce an SOP for requesting AXRs.