Penn-Developed Electronic Medical Record Tool Cuts Down on Unnecessary CT Scans in Emergency Room Patients with Abdominal Pain

A new electronic medical record tool that tallies patients’ previous radiation exposure from CT scans helps reduce potentially unnecessary use of the tests among emergency room patients with abdominal pain, according to a study from researchers at the Perelman School of Medicine at the University of Pennsylvania that will be presented today at the annual meeting of the Society for Academic Emergency Medicine. The new study shows that when the tool is in use, patients are 10 percent less likely to undergo a CT scan, without increasing the number of patients who are admitted to the hospital.

Abdominal pain is the most common reason why people seek care in emergency rooms in the United States, accounting for 10 million visits each year. But the symptoms may be caused by myriad problems, from those that can be fixed with a single dose of an over-the-counter drug to those that could prove life-threatening within hours: from a bout of GI distress to an ectopic pregnancy; from constipation to an appendix about to burst; from a hernia to signs of a chronic condition like Crohn’s disease.

This complex diagnostic face-off plays a huge role in why emergency physicians tend to lean heavily on tests like CT scans, even though they expose patients to radiation and there are few clear guidelines on which patients should get them. Since the mid-1990s, the use of CT scans to diagnose ER patients has surged, increasing ten-fold. Today, 14 percent of all emergency room patients get scanned -- a statistic experts often point to as a contributor to ballooning health care costs.

"Most patients with abdominal pain aren’t in major danger, but some of the conditions that are on the list of things we consider as causes can be fatal within a short amount of time," said Angela M. Mills, MD , an assistant professor of Emergency Medicine and medical director of the emergency department at the Hospital of the University of Pennsylvania. "We need to be sure about our diagnosis in order to keep patients safe, but we need to balance the risks of giving a test like a CT scan with the chance that the test will truly provide us with information we could not get in some other way with less risk to the patient."

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