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Published in: European Radiology 9/2013

01-09-2013 | HEALTH ECONOMY

Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial

Authors: Tiina Lehtimäki, Petri Juvonen, Hannu Valtonen, Pekka Miettinen, Hannu Paajanen, Ritva Vanninen

Published in: European Radiology | Issue 9/2013

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Abstract

Objectives

To evaluate the costs of treatment and use of hospital resources when comparing routine abdominal CT and selective imaging practice based on clinical assessment in patients with acute abdomen.

Methods

Altogether 300 patients with acute abdominal pain were randomised to computed tomography (CT, n = 150) or selective imaging practice (SIP, n = 150) groups. Final analysis included 254 patients, 143 in the CT and 111 in the SIP group. All CT group patients underwent contrast-enhanced abdominal CT within 24 h of admission. In the SIP group, imaging was individually tailored based on clinical assessment. The numbers of various examinations and procedures as well as costs of treatment arising from acute abdomen were calculated for each patient. Length of hospital stay was registered.

Results

Total treatment cost per patient was 1,202 euros (€) higher in the CT group compared to the SIP group (P = 0.002). The length of hospital stay was 1.2 days longer in the CT group (3.7 vs. 2.5 days, P = 0.010). Routine CT had no impact on ED discharge times. Imaging costs accounted for approximately 10 % of total costs.

Conclusion

Routine abdominal CT results in higher treatment costs compared to selective use of imaging in patients with acute abdomen.

Key Points

CT is widely used almost routinely in the diagnostics of acute abdomen.
Patients with acute abdomen were randomised to routine CT or selective imaging.
The treatment costs were significantly higher in the routine CT group.
Length of hospital stay was longer in the CT group.
Selective use of imaging may help control continuous increases of treatment costs.
Literature
1.
go back to reference Powers RD, Guertler AT (1995) Abdominal pain in the ED: Stability and change over 20 years. Am J Emerg Med 13:301–303PubMedCrossRef Powers RD, Guertler AT (1995) Abdominal pain in the ED: Stability and change over 20 years. Am J Emerg Med 13:301–303PubMedCrossRef
2.
go back to reference Nawar EW, Niska RW, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data 386:1–32PubMed Nawar EW, Niska RW, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data 386:1–32PubMed
3.
go back to reference Taourel P, Baron MP, Pradel J, Fabre JM, Seneterre E, Bruel JM (1992) Acute abdomen of unknown origin: Impact of CT on diagnosis and management. Gastrointest Radiol 17:287–291PubMedCrossRef Taourel P, Baron MP, Pradel J, Fabre JM, Seneterre E, Bruel JM (1992) Acute abdomen of unknown origin: Impact of CT on diagnosis and management. Gastrointest Radiol 17:287–291PubMedCrossRef
4.
go back to reference Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M (1997) Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. Am J Roentgenol 168:173–178CrossRef Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M (1997) Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. Am J Roentgenol 168:173–178CrossRef
5.
go back to reference Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13:25–30PubMedCrossRef Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13:25–30PubMedCrossRef
6.
go back to reference Pines JM (2009) Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain. Med Care 47:782–786PubMedCrossRef Pines JM (2009) Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain. Med Care 47:782–786PubMedCrossRef
7.
go back to reference Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K (2003) Doctors’ knowledge of radiation exposure: Questionnaire study. BMJ 327:371–372PubMedCrossRef Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K (2003) Doctors’ knowledge of radiation exposure: Questionnaire study. BMJ 327:371–372PubMedCrossRef
8.
go back to reference Balthazar EJ, Rofsky NM, Zucker R (1998) Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol 93:768–771PubMedCrossRef Balthazar EJ, Rofsky NM, Zucker R (1998) Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol 93:768–771PubMedCrossRef
9.
go back to reference Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA (1999) Introduction of appendiceal CT: Impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229:344–349PubMedCrossRef Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA (1999) Introduction of appendiceal CT: Impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229:344–349PubMedCrossRef
10.
go back to reference Guss DA, Behling CA, Munassi D (2008) Impact of abdominal helical computed tomography on the rate of negative appendicitis. J Emerg Med 34:7–11PubMedCrossRef Guss DA, Behling CA, Munassi D (2008) Impact of abdominal helical computed tomography on the rate of negative appendicitis. J Emerg Med 34:7–11PubMedCrossRef
11.
go back to reference Kim K, Lee CC, Song KJ, Kim W, Suh G, Singer AJ (2008) The impact of helical computed tomography on the negative appendectomy rate: A multi-center comparison. J Emerg Med 34:3–6PubMedCrossRef Kim K, Lee CC, Song KJ, Kim W, Suh G, Singer AJ (2008) The impact of helical computed tomography on the negative appendectomy rate: A multi-center comparison. J Emerg Med 34:3–6PubMedCrossRef
12.
go back to reference Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB Jr (2007) Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: Does its use reduce negative appendectomy rates and healthcare costs? Am Surg 73:580–584, discussion 584PubMed Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB Jr (2007) Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: Does its use reduce negative appendectomy rates and healthcare costs? Am Surg 73:580–584, discussion 584PubMed
13.
go back to reference Coursey CA, Nelson RC, Patel MB et al (2010) Making the diagnosis of acute appendicitis: Do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 254:460–468PubMedCrossRef Coursey CA, Nelson RC, Patel MB et al (2010) Making the diagnosis of acute appendicitis: Do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 254:460–468PubMedCrossRef
14.
go back to reference Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef
15.
go back to reference Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424PubMed Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424PubMed
16.
go back to reference Hong JJ, Cohn SM, Ekeh AP et al (2003) A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt) 4:231–239CrossRef Hong JJ, Cohn SM, Ekeh AP et al (2003) A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt) 4:231–239CrossRef
17.
go back to reference Pritchett CV, Levinsky NC, Ha YP, Dembe AE, Steinberg SM (2010) Management of acute appendicitis: The impact of CT scanning on the bottom line. J Am Coll Surg 210(699–705):705–707 Pritchett CV, Levinsky NC, Ha YP, Dembe AE, Steinberg SM (2010) Management of acute appendicitis: The impact of CT scanning on the bottom line. J Am Coll Surg 210(699–705):705–707
18.
go back to reference Stromberg C, Johansson G, Adolfsson A (2007) Acute abdominal pain: Diagnostic impact of immediate CT scanning. World J Surg 31:2347–2354, discussion 2355–2358PubMedCrossRef Stromberg C, Johansson G, Adolfsson A (2007) Acute abdominal pain: Diagnostic impact of immediate CT scanning. World J Surg 31:2347–2354, discussion 2355–2358PubMedCrossRef
19.
go back to reference Miettinen P, Pasanen P, Lahtinen J, Alhava E (1996) Acute abdominal pain in adults. Ann Chir Gynaecol 85:5–9PubMed Miettinen P, Pasanen P, Lahtinen J, Alhava E (1996) Acute abdominal pain in adults. Ann Chir Gynaecol 85:5–9PubMed
20.
go back to reference Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96:473–481PubMedCrossRef Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96:473–481PubMedCrossRef
21.
go back to reference Styrud J, Eriksson S, Nilsson I et al (2006) Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg 30:1033–1037PubMedCrossRef Styrud J, Eriksson S, Nilsson I et al (2006) Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg 30:1033–1037PubMedCrossRef
22.
go back to reference Ng CS, Watson CJ, Palmer CR et al (2002) Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: Prospective randomised study. BMJ 325:1387PubMedCrossRef Ng CS, Watson CJ, Palmer CR et al (2002) Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: Prospective randomised study. BMJ 325:1387PubMedCrossRef
23.
go back to reference Sala E, Watson CJ, Beadsmoore C et al (2007) A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol 62:961–969PubMedCrossRef Sala E, Watson CJ, Beadsmoore C et al (2007) A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clin Radiol 62:961–969PubMedCrossRef
24.
go back to reference Lameris W, van Randen A, van Es HW et al (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study. BMJ 338:b2431PubMedCrossRef Lameris W, van Randen A, van Es HW et al (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study. BMJ 338:b2431PubMedCrossRef
Metadata
Title
Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial
Authors
Tiina Lehtimäki
Petri Juvonen
Hannu Valtonen
Pekka Miettinen
Hannu Paajanen
Ritva Vanninen
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2848-4

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