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The routine use of contrast both oral and IV, and certainly rectal is unnecessary for the majority of abdominal CT scans performed in the ED. At least that is what the literature says over and over. Unfortunately, many radiologists disagree. Is their objection based on a sound analysis of the literature?
In most cases it is a matter of personal preference. They have been using contrast since their residency, or at least since CTs came on the scene, and just feel more comfortable with it. Have they made an honest effort to compare results with and without contrast?
But when the use of contrast is subject to the intense searchlight of scientific inquiry, the answer seems to be pretty clear. It is the atypical patient with nontraumatic abdominal pain who needs contrast.
That could be an entire column. What I want to talk about is the use of ultrasonography as a first test to visualize the abdominal contents and then, and only then, considering CT if results are equivocal and imaging is still felt to be necessary.
Even the American College of Radiology has taken the radical position that, at least in children with suspected appendicitis, an ultrasound should be considered as an option.
Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands.
Since ultrasound will reduce radiation exposure, ultrasound is the preferred initial consideration for imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent.
EPs can help them get this experience by ordering the correct test in these cases — an ultrasound and not a CT. EPs need to stop aiding and abetting this process. So, how about some papers indicating that oral contrast is a waste of time in the setting of suspected appendicitis — the most common setting in which oral contrast is used.
Instead of tediously going through study after study on this topic, here are two analyses, one published in involving seven high-quality trials and another in involving 23 trials. And catch the concluding sentence in the paper: In fact, the data shows it was a little better.
Non-contrast abdominal computed tomography CT is often used in the evaluation of suspected appendicitis, but its diagnostic accuracy has been questioned.
The authors, coordinated at Columbia University in New York, performed a systematic literature review, examining all relevant electronic databases and the bibliographies of pertinent studies and previous systematic reviews, to evaluate the accuracy of non-contrast helical CT in adult emergency department ED patients with suspected acute appendicitis.
There were specific inclusion and exclusion criteria, and two authors independently screened and chose articles, extracted data, and evaluated study quality.In a comparison/contrast essay, a writer must do the following: 1) Identify and explain three or more key points that two or more subjects have in common.
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