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Emergency Radiology |
1 From the Department of Radiology, Wilford Hall Medical Center, Lackland Air Force Base, Tex (A.B.M.H.A.C., J.E.T.); South Texas Radiology Group PA, San Antonio, Tex (M.J.L.); Departments of Emergency Medicine (R.T.G.) and Radiology (H.A.C., J.E.T.), Brooke Army Medical Center, Fort Sam Houston, Tex; Department of Emergency Medicine, Womack Army Medical Center, Fort Bragg, NC (S.K.); and Department of Radiology, Winthrop-University Hospital, Mineola, NY (D.S.K.). Received February 29, 2004; revision requested May 5; revision received October 6; accepted November 4. Address correspondence to A.B.M., 822 Coldwater Creek Circle, Niceville, FL 32578 (e-mail: amackersie{at}hotmail.com).
PURPOSE: To prospectively evaluate and compare the diagnostic accuracy of unenhanced helical computed tomography (CT) for patients with nontraumatic acute abdominal pain with that of traditional abdominal radiography.
MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained; this study was completed before implementation of the HIPAA. Ninety-one patients (44 men; 47 women; age range, 18–84 years; mean age, 48.5 years) with acute nontraumatic abdominal pain over a 7-month period were referred by the emergency department of one institution. These patients underwent a three-view acute abdominal series (AAS) and unenhanced helical CT. AAS included an upright chest radiograph and upright and supine abdominal radiographs. Unenhanced helical CT images with 5-mm collimation were obtained from the lung bases to the pubic symphysis, without intravenous, oral, or rectal contrast material. AAS and unenhanced helical CT images were each separately and prospectively interpreted by a different experienced radiologist who was blinded to patient history and the images and interpretation of the other examination for each patient. Final diagnosis was established with surgical, pathologic, and clinical follow-up. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and positive and negative likelihood ratios were calculated for AAS and unenhanced helical CT. Confidence intervals of 95% were calculated for each value with the standard equation for population proportions. Results of AAS and unenhanced helical CT examinations were compared with 
2 analysis.
RESULTS: Among the 91 patients examined, unenhanced helical CT yielded an overall sensitivity, specificity, and accuracy of 96.0%, 95.1%, and 95.6%, respectively. The AAS interpretations yielded an overall sensitivity, specificity, and accuracy of 30.0%, 87.8%, and 56.0%, respectively. The accuracy of unenhanced helical CT was significantly greater than the accuracy of AAS (P < .05).
CONCLUSION: AAS is an insensitive technique in the evaluation of nontraumatic acute abdominal pain in adults. Unenhanced helical CT is an accurate technique in the evaluation of adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality.
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