Master Sonali S, Longstreth George F, Liu Amy L
Department of Gastroenterology, Kaiser Permanente Medical Care Plan, San Diego, California 92120, USA.
Fam Pract. 2005 Oct;22(5):474-7. doi: 10.1093/fampra/cmi039. Epub 2005 Jun 17.
The utility of abdominal computerized tomography (CT) for evaluating abdominal pain in non-emergency, primary care outpatients is unknown. Family practice patients commonly report abdominal pain.
We reviewed the records of health maintenance organization primary care outpatients <2 years after they had undergone CT for abdominal pain and assessed demographic variables, clinical and laboratory data, CT findings and final diagnoses.
We studied 137 patients: age 58.1 +/- 16.1 years (mean +/- SD), 80 (58.4%) females. Fifty (36.5%) patients had > or =1 warning clinical or laboratory feature. Positive (etiologic) and negative CT reports and unrelated and multiple CT findings occurred in 16 (11.7%), 104 (75.9%), 16 (11.7%) and 1 (0.7%) patients, respectively. Positive findings occurred in 16 (32.0%) patients with > or =1 warning feature and 1 (1.2%) patient (including the 1 patient with multiple findings) with no warning feature (P < 0.0001). One (6.3%) unrelated finding led to treatment, ovariectomy for a benign tumor. Fifty-four (39.4%) patients had a final diagnosis.
A majority of outpatients who had CT for abdominal pain received no diagnosis, and CT was rarely diagnostic for patients lacking a warning feature. Positive and unrelated CT findings were equally prevalent, and the latter were not beneficial.
腹部计算机断层扫描（CT）在非急诊初级保健门诊患者腹痛评估中的效用尚不清楚。家庭医疗患者常报告腹痛。
我们回顾了健康维护组织初级保健门诊患者在因腹痛接受CT检查后不到2年的记录，并评估了人口统计学变量、临床和实验室数据、CT检查结果及最终诊断。
我们研究了137例患者，年龄58.1±16.1岁（均值±标准差），80例（58.4%）为女性。50例（36.5%）患者有≥1项警示性临床或实验室特征。CT报告阳性（病因明确）、阴性、无关及多项检查结果分别见于16例（11.7%）、104例（75.9%）、16例（11.7%）和1例（0.7%）患者。有≥1项警示特征的患者中16例（32.0%）有阳性发现，无警示特征的患者（包括1例有多项检查结果的患者）中1例（1.2%）有阳性发现（P<0.0001）。1例（6.3%）无关检查结果导致了治疗，即因良性肿瘤行卵巢切除术。54例（39.4%）患者有最终诊断。
大多数因腹痛接受CT检查的门诊患者未得到诊断，对于缺乏警示特征的患者，CT很少具有诊断价值。CT阳性和无关检查结果的发生率相当，且后者并无益处。
