Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Am J Emerg Med. 2011 Jul;29(6):582-589.e2. doi: 10.1016/j.ajem.2009.12.020. Epub 2010 Apr 24.
The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED).
In a multicenter prospective trial, patients with abdominal pain more than 2 hours and less than 5 days presented at the ED were evaluated clinically, and a diagnosis was made by the treating physician. Subsequently, all patients underwent supine abdominal and upright chest radiographs, after which the diagnosis was reassessed by the treating physician. A final (reference) diagnosis was assigned by an expert panel. The number of changes in the primary diagnosis, as well as the accuracy of these changes, was calculated. Changes in the level of confidence were evaluated for unchanged diagnoses.
Between March 2005 and November 2006, 1021 patients, 55% female, mean age 47 years (range, 19-94 years), were included. In 117 of 1021 patients, the diagnosis changed after plain radiographs, and this change was correct in 39 patients (22% of changed diagnoses and 4% of total study population). Overall, the clinical diagnosis was correct in 502 (49%) patients. The diagnosis after evaluation of the radiographs was correct in 514 (50%) patients, a nonsignificant difference (P = .14). In 65% of patients with unchanged diagnosis before and after plain radiography, the level of confidence of that diagnosis did not change either.
The added value of plain radiographs is too limited to advocate their routine use in the diagnostic workup of patients with acute abdominal pain, because few diagnoses change and the level of confidence were mostly not affected.
本研究旨在评估在急诊科（ED）就诊的急性腹痛非选择性患者中，除临床评估外，增加常规 X 线平片检查的价值。
在一项多中心前瞻性试验中，评估了腹痛时间超过 2 小时且小于 5 天的 ED 患者，由主治医生进行临床诊断。随后，所有患者接受仰卧位腹部和直立位胸部 X 线检查，之后由主治医生重新评估诊断。最终（参考）诊断由专家小组确定。计算了主要诊断的改变数量及其准确性。对于未改变的诊断，评估了信心水平的变化。
2005 年 3 月至 2006 年 11 月期间，共纳入 1021 例患者，其中 55%为女性，平均年龄 47 岁（范围 19-94 岁）。在 1021 例患者中有 117 例患者的诊断在 X 线平片后发生改变，其中 39 例（22%的改变诊断和 4%的总研究人群）的改变是正确的。总体而言，502 例（49%）患者的临床诊断是正确的。在评估 X 线平片后，514 例（50%）患者的诊断是正确的，两者无显著差异（P=0.14）。在 X 线平片前后诊断未改变的 65%患者中，该诊断的信心水平也未改变。
常规 X 线平片的附加价值有限，不能提倡其常规用于急性腹痛患者的诊断评估，因为改变的诊断很少，且信心水平大多未受影响。
