TY - JOUR
T1 - Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital
T2 - diagnostic implications, turnaround times, and assessment of ED physician ordering
AU - Jensen, Corey T.
AU - Blair, Katherine J.
AU - Le, Ott
AU - Sun, Jia
AU - Wei, Wei
AU - Korivi, Brinda Rao
AU - Morani, Ajaykumar C.
AU - Wagner-Bartak, Nicolaus A.
N1 - Funding Information:
Funding This study was supported by institutional CCSG (cancer center support Grant) from the NIH/National Cancer Institute under award number P30CA016672.
Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Purpose: To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To the best of our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. Materials & methods: Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month. CT examinations performed with and without oral contrast were rated by two consensus readers for degree of confidence and diagnostic ability. Correlations were assessed for primary cancer type, age, sex, chief complaint/examination indication, body mass index, intravenous contrast status, repeat CT examination within 4 weeks, and disposition. Turnaround times from order to the start of the CT examination were calculated. Results: The studied group consisted of 267 patients (127 men and 140 women) with a mean age of 56 years and a mean body mass index of 27.8 kg/m2. One hundred sixty CT examinations were performed without oral contrast, and 107 CT examinations were performed with oral contrast. There was no significant difference between cases with oral contrast and cases without oral contrast in the number of cases rated as “improved confidence” (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.23–1.31, P = 0.17), “improved diagnosis” (OR 0.58, 95% CI 0.20–1.64, P = 0.3), “impaired confidence” (OR 3.92, 95% CI 0.46–33.06, P = 0.21), or “impaired diagnosis” (OR 2.63, 95% CI 0.29–23.89, P = 0.39). The turnaround time in the group receiving oral contrast (mean, 141 min; standard deviation, 49.8 min) was significantly longer than that in the group not receiving oral contrast (mean, 109.2 min; standard deviation, 64.8 min) with a mean difference of 31.8 min (P < 0.0001). Conclusion: On the basis of our findings and prior studies, targeted rather than default use of oral contrast shows acceptable diagnostic ability in the emergency setting for oncology patients. Benefit from oral contrast use is suggested in scenarios such as suspected fistula/bowel leak/abscess, hypoattenuating peritoneal disease, prior bowel surgery such as gastric bypass, and the absence of intravenous contrast administration. Improvement through the use of targeted oral contrast administration also supports the emergency department need for prompt diagnosis and disposition.
AB - Purpose: To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To the best of our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. Materials & methods: Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month. CT examinations performed with and without oral contrast were rated by two consensus readers for degree of confidence and diagnostic ability. Correlations were assessed for primary cancer type, age, sex, chief complaint/examination indication, body mass index, intravenous contrast status, repeat CT examination within 4 weeks, and disposition. Turnaround times from order to the start of the CT examination were calculated. Results: The studied group consisted of 267 patients (127 men and 140 women) with a mean age of 56 years and a mean body mass index of 27.8 kg/m2. One hundred sixty CT examinations were performed without oral contrast, and 107 CT examinations were performed with oral contrast. There was no significant difference between cases with oral contrast and cases without oral contrast in the number of cases rated as “improved confidence” (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.23–1.31, P = 0.17), “improved diagnosis” (OR 0.58, 95% CI 0.20–1.64, P = 0.3), “impaired confidence” (OR 3.92, 95% CI 0.46–33.06, P = 0.21), or “impaired diagnosis” (OR 2.63, 95% CI 0.29–23.89, P = 0.39). The turnaround time in the group receiving oral contrast (mean, 141 min; standard deviation, 49.8 min) was significantly longer than that in the group not receiving oral contrast (mean, 109.2 min; standard deviation, 64.8 min) with a mean difference of 31.8 min (P < 0.0001). Conclusion: On the basis of our findings and prior studies, targeted rather than default use of oral contrast shows acceptable diagnostic ability in the emergency setting for oncology patients. Benefit from oral contrast use is suggested in scenarios such as suspected fistula/bowel leak/abscess, hypoattenuating peritoneal disease, prior bowel surgery such as gastric bypass, and the absence of intravenous contrast administration. Improvement through the use of targeted oral contrast administration also supports the emergency department need for prompt diagnosis and disposition.
KW - Abdominal
KW - Bowel
KW - Emergency
KW - Oral contrast
KW - Turnaround time
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U2 - 10.1007/s00261-017-1175-7
DO - 10.1007/s00261-017-1175-7
M3 - Article
C2 - 28523416
AN - SCOPUS:85019543670
SN - 2366-004X
VL - 42
SP - 2760
EP - 2768
JO - Abdominal Radiology
JF - Abdominal Radiology
IS - 11
ER -