Plain abdominal radiography in acute abdominal pain--is it really necessary?

The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and attitudes of emergency physicians with regard to ordering AXRs in patients presenting with acute abdominal pain. A retrospective study was undertaken at an ED of a tertiary hospital in Tasmania using clinical notes on patient presenting with acute abdominal pain who underwent an AXR. The study also included a short questionnaire, which assessed emergency physicians' knowledge of current imaging guidelines and clinical practice when ordering an AXR. During the study period, 108 patients satisfied the selection criteria, and the AXR was reported as normal in 76 % (n = 82; p value <0.05), non-specific in 12 % (n = 13; p value <0.05) and abnormal in 12 % (n = 13; p value <0.05) of patients. Of those patients, 25 % (n = 27) of the AXRs did not meet indications listed in the Diagnostic Imaging Pathways published by the Western Australia Department of Health and were found not to benefit patient care. Of the 19 doctors who completed the survey, only 16 % (n = 3) were aware of any clinical guidelines for imaging in this setting. Current guidelines should be followed when ordering imaging for patients with acute abdominal pain to minimise unnecessary patient radiation exposure, avoid delays in diagnosis and definitive patient management, reduce costs and therefore increase efficiency in ED.