Sala E, Watson C J E, Beadsmoore C, Groot-Wassink T, Fanshawe T R, Smith J C, Bradley A, Palmer C R, Shaw A, Dixon A K
Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
Clin Radiol. 2007 Oct;62(10):961-9. doi: 10.1016/j.crad.2007.01.030. Epub 2007 Jul 2.
To compare the effect of an initial early computed tomography (CT) examination versus standard practice (SP) on the length of hospital stay, diagnostic accuracy, and mortality of adults presenting with acute abdominal pain.
Two hundred and five adults presenting with acute abdominal pain were randomized to undergo an early CT examination or current SP, which comprised supine abdominal and erect chest radiography. One hundred and ninety-eight patients (99 in each arm) were included in the analysis. The primary endpoint was the duration of inpatient stay; secondary endpoints were diagnostic certainty and mortality.
There was no significant difference in the length of hospital stay between the two arms (p=0.20). At randomization 36% (35 of 96) of CT patients and 49% (48 of 98) of SP patients were correctly diagnosed; 24h after randomization the correct diagnosis had been established in 84% of CT patients and 73% of SP patients. This refinement in diagnostic certainty was significantly better in the CT group (p<0.001). There was no difference in mortality between the two trial arms (p=0.31).
Early abdominal CT in patients with acute abdominal pain improves diagnostic certainty, but does not reduce the length of hospital stay and 6 month mortality.
比较初始早期计算机断层扫描（CT）检查与标准做法（SP）对成人急性腹痛患者住院时间、诊断准确性及死亡率的影响。
205例成人急性腹痛患者被随机分为早期CT检查组或现行标准做法组，标准做法包括仰卧位腹部及立位胸部X线摄影。198例患者（每组99例）纳入分析。主要终点为住院时间；次要终点为诊断确定性及死亡率。
两组住院时间无显著差异（p = 0.20）。随机分组时，CT组36%（96例中的35例）患者及SP组49%（98例中的48例）患者被正确诊断；随机分组24小时后，CT组84%患者及SP组73%患者确诊。CT组诊断确定性的改善显著更好（p < 0.001）。两组间死亡率无差异（p = 0.31）。
急性腹痛患者早期腹部CT可提高诊断确定性，但不缩短住院时间及降低6个月死亡率。
