Computed Tomography of the Abdomen and Pelvis Ordering in the Emergency Department: A Prospective Analysis of Provider Gestalt.

OBJECTIVE

To evaluate the rate of concordance between computed tomography of the abdomen and pelvis (CTAP) results and an emergency medicine (EM) provider's gestalt of obtaining an actionable CTAP result.

METHODS

In this prospective study, we recruited EM providers to complete questionnaires after ordering CTAP scans for patients during ED encounters. Participants recorded whether they anticipated an actionable result and the confidence level of their suspicion. We determined whether the CTAP was actionable or nonactionable based on the radiology report or actions of the treatment team. The primary outcome was how frequently CTAP results matched an EM provider's suspicion of obtaining an actionable CTAP finding. Secondary outcomes were the difference in concordance rates between the attending and learner cohorts, along with the effect of confidence on the performance of gestalt.

RESULTS

We analyzed 219 questionnaires, 110 from the attending group and 109 from the learner group. For the primary outcome, the relationship between EM provider gestalt and actionable CTAP results was statistically significant (P < .001) as 60% of respondents obtained a CTAP result that matched their clinical suspicion. Gestalt was 81% sensitive and 44% specific for actionable CTAP findings in our sample. For the secondary outcomes, learners outperformed attendings in predicting CTAP results (P < .001) but attendings missed fewer actionable results than learners. Participants recorded higher confidence levels when suspecting an actionable result compared to a non-actionable result (P < .001), but confidence did not affect the likelihood of gestalt achieving concordance with CTAP findings (P > .05).

CONCLUSIONS

Our study demonstrated that the diagnostic accuracy of an EM providers' gestalt was not clinically sufficient for actionable or non-actionable CTAP results in ED patients with abdominopelvic complaints despite a significant association between gestalt and CTAP findings.