The use of imaging techniques (US and CT) in case of acute abdominal pain no doubts gives help but with high costs, without thinking to radiation exposure caused by CT. Through a Dutch multicentric and prospective trial, 1021 adults with abdominal pain of a duration between 2 hours and 5 days have been studied to determine the optimal diagnostic strategy. Everyone underwent clinical examination, blood tests and standard X-ray. After diagnosis was given in this way, everyone underwent US and CT, with a new record for diagnosis (the radiologist performing X-ray wasn’t able to see ultrasonography and vice versa). Every diagnosis was then compared with final diagnosis, given after 6 months, when the episode had ended. In a retrospective way, urgency conditions have been identified in 65% of patients. The use of US or CT reduced the number of false urgent diagnoses and CT showed to be more sensitive than ultrasonography, even if the greatest sensitiveness was obtained with the performance of ultrasonography to all patients followed by CT in case of negative or non-conclusive US (94% of sensitiveness, with only 6% of false negatives). This technique allowed to limit radiation exposure only for 49% of patients. Diagnostic strategies based on pain localization, age, BMI have shown a lower sensitiveness than the above mentioned strategy.
The trial confirms the greater sensitiveness of CT than ultrasonography, but given the high number of ionizing radiations to which the patient is exposed, the best strategy seems to be to perform a US followed by a CT in case of doubts or negative US.
