Is the devil in the detail? The quality and clinical impact of information provided on requests for non-trauma emergency abdominal CT scans

Abstract

Background The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests. Purpose To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes. Material and Methods We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians’ referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis. Results Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome. Conclusion Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.