Final Research Proposal
Abstract: What are outcomes for the patient needing abdominal CT scans in the ER: po contrast verses no contrast? The effects of contrast related to length of stay in the emergency room. Accuracy of diagnostic evaluation of CT scans for patients presenting with non-traumatic abdominal pain.
FINAL RESEACH PROPOSAL
In identifying the need to research the necessity of po contrast for patients presenting to the emergency department with non-traumatic abdominal pain the length of stay and the accuracy of the test done with and without contrast was compared and analyzed to see if patient care will be improved or decreased with the omission of po contrast. According to the golden standard of emergency medicine ct exams are the standard diagnostic tool to diagnose many abdominal illnesses, such as, appendicitis, diverticulitis, kidney stones, colitis, abscesses, bowel obstructions ulcerative colitis, Crohn’s disease, abdominal aortic aneurysms, perforated bowels just to name a few. Many of the disease processes listed can be fatal if not treated in an emergent setting. Some require immediate surgical interventions. At this time there is no requirement for po contrast with a diagnosis of kidney stone or abdominal aortic aneurysm, this is done with only IV contrast. The others all require gastrographin which is prepared in 700 cc of water or juice and administered over a two hour period before the patient is taken to the scanner to then wait for the radiologist to read the scan, requiring another thirty to sixty minute waiting time before receiving an actual diagnosis. The average waiting time for a pelvic/abdominal ct with contrast in the emergency room is approximately 180 minutes. That is without any complications such as vomiting, allergic reaction or the patient falling asleep and not drinking the contrast on time. The number one complaint of patient surveyed after an emergency room visit is the amount of time spent waiting. To be able to decrease the length of stay of each patient needing a ct by ninety minutes would decrease the amount of time patients waited in the waiting room for that same bed to become available. We cannot eliminate po contrast if the tests will no longer be accurate. “In fact, according to the results of a meta-analysis of 23 studies looking at the accuracy of abdominal ct for acute appendicitis, with and without oral contrast, unenhanced ct sensitivity rates were similar to enhanced (95% vs. 92%) as were specificity (97% vs. 94%) and accuracy (97% vs. 89%)”(Luczczak,2010). The conclusion regarding oral contrast is that the length of stay is increased and the accuracy remains unaffected. This study was primarily looking at appendicitis, however there are further studies that show virtually the same results for the other abdominal diseases previously mentioned as well. A presentation presented at the Boston Scientific Assembly by Dr. Lim an Emergency physician from a Kaiser facility in San Francisco. This presentation has a level I rating as it shows many randomized controlled trials with excellent evidence of all the findings that supported a large sample size and large effect size as well (Houser, p 26). As part of the presentation there was evidence regarding the ability to clearly see abnormalities in CT without contrast, such as renal stones, appendicitis, bowel obstructions, perforated viscus, cholecystitis, pancreatitis, diverticulitis, as well as AAA or rupture. Using a level I randomized control trial is an affective way to verify and justify findings of an experiment. With a large sample size it is more likely to see possible inconsistencies with different type of patients and be less biases in the findings. Another study using a level IIIB rating as it did not give multiple randomized controls but it did provide evidence from studies of intact groups (Houser p 26). This article presented facts about both PO and IV contrast and the evidence...
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