Do C-reactive protein level, white blood cell count, and pain location guide the selection of patients for computed tomography imaging in non-traumatic acute abdomen?
Özet
The value of abdominal computed tomography in
non-traumatic abdominal pain has been well established. On
the other hand, to manage computed tomography, appropriateness
has become more of an issue as a result of the concomitant
increase in patient radiation exposure with increased
computed tomography use. The purpose of this study was to
investigate whether C-reactive protein, white blood cell count,
and pain location may guide the selection of patients for computed
tomography in non-traumatic acute abdomen. Patients
presenting with acute abdomen to the emergency department
over a 12-month period and who subsequently underwent
computed tomography were retrospectively reviewed. Those
with serumC-reactive protein and white blood cell count measured
on admission or within 24 h of the computed tomography
were selected. Computed tomography examinations were
retrospectively reviewed, and final diagnoses were designated
either positive or negative for pathology relating to presentation
with acute abdomen. White blood cell counts, C-reactive
protein levels, and pain locations were analyzed to determine
whether they increased or decreased the likelihood of producing
a diagnostic computed tomography. The likelihood ratio
for computed tomography positivity with a C-reactive protein
level above 5 mg/L was 1.71, while this increased to 7.71 in
patients with combined elevated C-reactive protein level and
white blood cell count and right lower quadrant pain.
Combined elevated C-reactive protein level and white blood
cell count in patients with right lower quadrant pain
may represent a potential factor that could guide the
decision to perform computed tomography in non-traumatic
acute abdomen.