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National multicentre audit of current UK practice in the use of abdominal x rays for the investigation of acute abdominal pain
EP34210
Poster Title: National multicentre audit of current UK practice in the use of abdominal x rays for the investigation of acute abdominal pain
Submitted on 23 Oct 2020
Author(s): The Radiology Academic Network for Trainees (RADIANT)
Affiliations: The Radiology Academic Network for Trainees (RADIANT)
Poster Views: 1,200
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Poster Information
Abstract: Background
Abdominal x-rays (AXRs) are often an insensitive investigation for acute abdominal pain, and there is widespread variation in their utilisation (1). The aim of this audit was to 1: examine AXR request compliance with national RCR iRefer guidelines (2), and 2: examine the clinical value of AXRs.

Methods
All AXRs performed in the setting of acute abdominal pain across 14 UK hospitals during a week in March 2019 were examined against the iRefer guidelines. The audit was performed through the recently formed RCR Radiology Academic Network for Trainees (RADIANT).

Results
In total, approximately 50000 radiographs were performed in one week, and 1540 of these were AXRs to investigate acute abdominal pain. 95.1% (1464/1540) of AXRs were requested in accordance with iRefer guidelines. However, 42.4% (653/1540) of patients underwent subsequent imaging for abdominal pain within seven days, and 31.2% (204/653) of these subsequent studies were performed before the AXR was reported. A chi-squared test of independence revealed no statistically significant difference (X2 (1, N=1232) = 1.19, p=0.28) in the number of patients who underwent additional imaging within seven days between those who did have acute findings reported on AXR (33% (47/141)) and those who did not (28% (311/1091)).

Conclusion
The majority of AXRs are requested in accordance with national guidelines. However, a large proportion of patients undergo further cross-sectional imaging. Furthermore, patients with and without acute AXR findings are equally likely to undergo further imaging. These findings cast doubt over the utility of AXRs in the acute setting.

Summary: All AXRs performed in the setting of acute abdominal pain across 14 UK hospitals during a week in March 2019 were examined against the iRefer guidelines. The majority of AXRs are requested in accordance with national guidelines. However, a large proportion of patients undergo further cross-sectional imaging, which casts doubt over the utility of AXRs in the acute setting.References:
References
1. Boermeester, M., Gans, S., Stoker, J. and Boermeester, M., 2012. Plain abdominal radiography in acute abdominal pain; past, present, and future. International Journal of General Medicine, p.525.
2. The Royal College of Radiologists (2020) RCR iRefer guidelines, Available at: https://www.irefer.org.uk/guidelines
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