The Need for Surgery in Acute Abdominal Pain: A Randomized Study of Abdominal Computed Tomography

Abstract

Aim: To assess the need for surgical treatment in patients with acute abdominal pain in a prospective randomized study. Patients and Methods: Initially 203 patients with acute abdominal pain were randomized to the routine abdominal computed tomography CT (rCT, n=118), or selective abdominal CT group (sCT, n=85) over a period of 16 months. Ninety-three of the randomized patients (45.8%) underwent the study design and were reached for follow-up at three months. Results: Diagnostic accuracy improved significantly in the rCT group (p<0.001). The surgeon's assessment of the need for surgery changed more often in the rCT group than in the sCT group (78.7% vs. 46.9%, p=0.002). The confidence to treat operatively increased significantly in the rCT vs. the sCT group (65.6% vs. 40.6%, p=0.028). The rCT was the only independent parameter for the change of the assessment of surgery. Conclusion: Routine CT allows for more confidence in decision making for the surgical treatment of patients with acute abdominal pain.