CT abdomen IV contrast vs IV & oral contrast

[woodhorse22]

THis is a question I had been wondering about... When do you guys order IV and oral contrast for a abdominal CT scan? In other words, when would you definitely add oral contrast? From what I understand IV contrast is sufficient for things like diverticulitis, colitis. At my shop, IV contrast ONLY is sufficient for the following:
BMI > 20
Age > 25
No history of GI tract altering surgery (e.g. gastric bypass)
No history or suspicion of inflammatory bowel disease
No abdominal or pelvic surgery within the last 30 days.

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[exsanguination]

Your department is living in the past. There is good data out there that supports IV contrast only in just about all of the situations you describe. I still use oral contrast for gastric bypass evaluation, other than that I can't think of another reason.

The best way to fight this is from an administrative point of view is to sell it is a throughput issue. Have admin be the bad guy on this one (as much as I hate to do it to our radiologist colleagues).

 

[RustedFox]

Your department is living in the past. There is good data out there that supports IV contrast only in just about all of the situations you describe. I still use oral contrast for gastric bypass evaluation, other than that I can't think of another reason.

The best way to fight this is from an administrative point of view is to sell it is a throughput issue. Have admin be the bad guy on this one (as much as I hate to do it to our radiologist colleagues).

I'll argue that the exception here is the presence of inflammatory bowel disease.
As an IBD/UC patient, it does make a difference in terms of evaluation, for sure.
Whether its emergent or not can be argued.

 

[swamprat]

Radiology friend of mine says they only need PO when patient is really skinny. The BMI cut off varies by place I work at. The visceral fat is good contrast he says. At my main place though radiology states it's still in their guidelines that the ideal study is PO and IV for just about everything and always wants both.


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[hypnix]

Maybe if poor renal function and really need the contrast.
As mentioned about for patients with Crohn's to see if weird fistulas or leaking anastomosis.

 

[gutonc]

Your department is living in the past. There is good data out there that supports IV contrast only in just about all of the situations you describe. I still use oral contrast for gastric bypass evaluation, other than that I can't think of another reason.

The best way to fight this is from an administrative point of view is to sell it is a throughput issue. Have admin be the bad guy on this one (as much as I hate to do it to our radiologist colleagues).

I'm not the OP, but it reads to me like s/he's saying all those situations are OK for IV only, which you (and everyone who has actually thought this through, or looked at the literature) agrees with.

I work within a hospital system that has 5 different hospitals that employs 4 different radiology groups. Only one of the groups (the one at the hospital where I practice) appears to be even remotely familiar with current literature. So, whenever I order a scan, I tell the patient to refuse oral contrast.

 

[Siggy]

Maybe if poor renal function and really need the contrast.

That's not how contrast works.

 

[WilcoWorld]

I'll argue that the exception here is the presence of inflammatory bowel disease.
As an IBD/UC patient, it does make a difference in terms of evaluation, for sure.
Whether its emergent or not can be argued.

Yeah, CT enterography is the main literature-supported reason to still give a **** about oral contrast. The diagnoses facilitated by it are rarely, if ever, emergent. That being said, whenever possible, it's best for the IBD patient to get one CT, rather than two (e.g.: IV on Sunday, PO on Wednesday).

 

[WilcoWorld]

Radiology friend of mine says they only need PO when patient is really skinny.

You might want to show your friend some literature. This mainly applicable to IV contrast, not oral.

 

[hypnix]

That's not how contrast works.

I should clarify. I never really used oral contrast. But I would consider barium or some other less nephrotoxic agent and if a contrast study of the abdomen was desired in someone with renal disease not already on HD

 

[Venko]

I'll argue that the exception here is the presence of inflammatory bowel disease.
As an IBD/UC patient, it does make a difference in terms of evaluation, for sure.
Whether its emergent or not can be argued.

I second this. We use plain water as the contrast agent.


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[migm]

for me? depends on which radiologist is working. painful... "examination of the bowel is limited by the lack of oral contrast"

god dammnit.

 

[DrBowtie]

for me? depends on which radiologist is working. painful... "examination of the bowel is limited by the lack of oral contrast"

god dammnit.

I mean that statement is true. You aren't going to get a good evaluation of the bowel lumen without it, but my guess is that over 99% of the reasons you are getting the scan isn't for GI lumen issues so it shouldn't matter to you. For the main luminal issue you would be dealing with, GI Bleed, you don't want PO contrast anyway.

 

[deleted109597]

I should clarify. I never really used oral contrast. But I would consider barium or some other less nephrotoxic agent and if a contrast study of the abdomen was desired in someone with renal disease not already on HD

Still not making any sense.
We don't inject barium. And it won't help define extraluminal structures.
Also, CIN is a myth in 2017 (not to say it wasn't 10 years ago, but we aren't using the same contrast agents or volumes as 10 years ago).
Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. - PubMed - NCBI

 

[shoal007]

i still use PO in 2 situations gastric bypass and the kid looking for appy. the horror! im cting bellys for appys in kids. I prefer not to but dont really have a choice.

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[hypnix]

Still not making any sense.
We don't inject barium. And it won't help define extraluminal structures.
Also, CIN is a myth in 2017 (not to say it wasn't 10 years ago, but we aren't using the same contrast agents or volumes as 10 years ago).
Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. - PubMed - NCBI

Barium for patient to drink...

 

[vm26]

for me? depends on which radiologist is working. painful... "examination of the bowel is limited by the lack of oral contrast"

god dammnit.

PO contrast would be most useful in r/o appy in thin patients (particularly peds), finding transition point in high grade/complete SBO, evaluating post-surgical GI tract (particularly to r/o anastomotic leak/stricture)

Honestly the statement "examination of the bowel is limited by the lack of oral contrast" should be "limited by under distention". Evaluating bowel distended by stool should not be limited

 

[RustedFox]

I second this. We use plain water as the contrast agent.


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I don't follow.

 

[Venko]

I don't follow.

I agree that for UC and crohns, having oral contrast agent is particularly helpful. We use plain water as the contrast most of the time.




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[deleted109597]

Barium for patient to drink...

Nobody uses barium for CT contrast. It's way too dense.

 

[deleted109597]

It is important to note that oral contrast may improve the diagnostic accuracy of abdominal CT scans in some circumstances. Both IV and oral contrast may be beneficial in individuals with low body mass index who lack sufficient mesenteric fat to demonstrate periappendiceal fat stranding associated with appendicitis. Two studies suggest that oral contrast may be beneficial in individuals with a BMI≤25 due to their lack of mesenteric fat. Oral contrast may also prove useful in individuals with inflammatory bowel disease, gastric perforation, and in those with a history of bowel altering surgery with a clinical suspicion of intestinal obstruction. ACEP clinical policy currently states that diagnostic imaging with oral contrast is not required in the evaluation of blunt abdominal trauma (Level B Recommendation).

Our (EP) clinical policy
http://www.annemergmed.com/article/S0196-0644(09)01644-8/fulltext
What one prominent EP says (although the comments are full blown JAFERD territory)
Contrast Is Unnecessary for Most Abdominal CTs - Emergency Physicians Monthly
What the surgeons say.
A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. - PubMed - NCBI

Noncontrast CT techniques to diagnose appendicitis showed equivalent or better diagnostic performance compared with CT scanning with oral contrast. A prospective comparative trial of CT with and without oral contrast for appendicitis should be performed to assess the adequacy of this modality.

Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis: Comparative Effectiveness in a Prospective Surgical Cohort

Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.

And the radiologists
http://www.academicradiology.org/article/S1076-6332(17)30066-1/fulltext?cc=y=

Our study shows that oral contrast is noncontributory to radiological diagnosis in most patients presenting to the ED with acute nontraumatic abdominal pain. These patients can therefore undergo abdominal CT scanning without oral contrast, with no effect on radiological diagnostic performance.

 

[hypnix]

Nobody uses barium for CT contrast. It's way too dense.

Good to know. I am not sure what oral contrast is to be honest. I just know it's contrast and makes radiologists happier. I figured you would use it for rule out bowel perfs, weird fistulas, and since most hospitals won't scan if GFR is too low, then oral contrast would be a substitute for IV. Given that most places make you wait 2 hours, I just get a non-contrast CT.

 

[deleted109597]

Good to know. I am not sure what oral contrast is to be honest. I just know it's contrast and makes radiologists happier. I figured you would use it for rule out bowel perfs, weird fistulas, and since most hospitals won't scan if GFR is too low, then oral contrast would be a substitute for IV. Given that most places make you wait 2 hours, I just get a non-contrast CT.

The point is Oral and IV contrast give you different answers. They aren't to look at the same thing. One tells you what's inside the lumen, the other the vasculature and the collecting system of the kidneys.

 

[racerwad]

Good to know. I am not sure what oral contrast is to be honest. I just know it's contrast and makes radiologists happier. I figured you would use it for rule out bowel perfs, weird fistulas, and since most hospitals won't scan if GFR is too low, then oral contrast would be a substitute for IV. Given that most places make you wait 2 hours, I just get a non-contrast CT.

If you're not sure what PO contrast is, should you even be ordering CT imaging?

 

[e30ftw]

If you work at a shop that regularly orders PO contrasted abd CT scans, you have an excellent opportunity to drastically improve LOS metrics and reduce LWBS while increasing patient satisfaction, reducing costs, with literally no downsides.

Just approach your med director and then admin with a nicely put together powerpoint (would take maybe 1 hr) of the studies Dr McNinja referenced above and a brief estimation of the improvements in los/lwbs metrics due to CT abd results being available in 1 hr instead of 6 hrs. You will instantly be a superstar..

 

[DrBowtie]

I don't follow.

Water is basically a neutral enteric contrast vs. traditional enteric contrast which is positive contrast. Both provide bowel distention which helps evaluate the bowel wall. Positive enteric contrast helps for leak or fistula because it increases the conspicuity.

 

[Venko]

If you work at a shop that regularly orders PO contrasted abd CT scans, you have an excellent opportunity to drastically improve LOS metrics and reduce LWBS while increasing patient satisfaction, reducing costs, with literally no downsides.

Just approach your med director and then admin with a nicely put together powerpoint (would take maybe 1 hr) of the studies Dr McNinja referenced above and a brief estimation of the improvements in los/lwbs metrics due to CT abd results being available in 1 hr instead of 6 hrs. You will instantly be a superstar..

Should include radiology leadership in the discussion if you want real success


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[RustedFox]

Water is basically a neutral enteric contrast vs. traditional enteric contrast which is positive contrast. Both provide bowel distention which helps evaluate the bowel wall. Positive enteric contrast helps for leak or fistula because it increases the conspicuity.

Yeah, I read it all wrong. Sorry.

 

[Siggy]

If you're not sure what PO contrast is, should you even be ordering CT imaging?

No, but I'd bet you don't let your med students order CT scans either.

 

[Siggy]

Good to know. I am not sure what oral contrast is to be honest. I just know it's contrast and makes radiologists happier. I figured you would use it for rule out bowel perfs, weird fistulas, and since most hospitals won't scan if GFR is too low, then oral contrast would be a substitute for IV. Given that most places make you wait 2 hours, I just get a non-contrast CT.

If the patient has a perf, then they're likely going to have peritoneal signs... in which case the test of choice is an upright chest x-ray. If that's positive, then pretty much the only reason to get a CT is if it's taking too long to mobilize the OR team.

 

[RustedFox]

If the patient has a perf, then they're likely going to have peritoneal signs... in which case the test of choice is an upright chest x-ray. If that's positive, then pretty much the only reason to get a CT is if it's taking too long to mobilize the OR team.

I have had plenty of self-contained small perfs that were evident only on CT and not on upright KUB/acute abd.series.

One in particular was an Ulcerative Colitis patient who had perfed and had a benign exam because of the megadoses of steroids that she was on. I had a talk with her and her husband about going for KUB instead of CT abdomen because of the risks of radiation exposure, the lack of free air on KUB, and a benign/reassuring exam.

I went to work the next day and Colorectal surgeon let me know what I had missed after her colectomy + ileostomy/J-pouch surgery. He was actually cool about it. The roids altered not only my exam, but his as well.

The abdomen is weird like that. Be careful with IBD. CT for the win.

 

[meister]

If you work at a shop that regularly orders PO contrasted abd CT scans, you have an excellent opportunity to drastically improve LOS metrics and reduce LWBS while increasing patient satisfaction, reducing costs, with literally no downsides.

Just approach your med director and then admin with a nicely put together powerpoint (would take maybe 1 hr) of the studies Dr McNinja referenced above and a brief estimation of the improvements in los/lwbs metrics due to CT abd results being available in 1 hr instead of 6 hrs. You will instantly be a superstar..

Faster TATs don't improve throughout if it still takes eyeballs a long time to actually look at the results.

I'm tempted to say "tough ****" to anyone who doesn't have to sign their name at the end of the report and take the liability when it comes to getting oral contrast. Particularly if confronted with ED literature supporting it just out of spite/pettiness (shocking their own literature would push for something that lowers throughout, though obviously I'm aware of the radiology literature as well). However, in my experience, it only makes a difference pretty infrequently. Usually post-surgical or pediatric bellies. So I'm a water versus nothing at all rad when I'm on call. And I've had the ED staff say they appreciate that.

That being said, most dinosaur attendings swear by oral contrast. Not gonna change their minds.

 

[WheezyBaby]

Still not making any sense.
We don't inject barium. And it won't help define extraluminal structures.
Also, CIN is a myth in 2017 (not to say it wasn't 10 years ago, but we aren't using the same contrast agents or volumes as 10 years ago).
Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. - PubMed - NCBI

Are your nephrology colleagues on board with this / are you fine giving IV contrast to IVVD CKD 4/5 patient? I'm admittedly no expert of the literature here, and I last rotated through nephrology in 2016, but nephrologists seemed pretty keen on the validity of CIN as an entity, and the pathophysiology was, to my understanding, at least reasonably well investigated. The authors highlighted well the limitations of their study, though it's admittedly still fairly compelling

 

[GeneralVeers]

I never order PO contrast. Since 75% of scans are negative anyway, I don't want to hold up ED throughput for an exam where I am just "going through the motions" to please the patient.

On the rare occasion I get pushback from a radiologist, I just state that the patient had nausea and vomiting, and would not tolerate PO contrast.

 

[Gadofosveset]

Both the pro and anti camps for positive PO contrast are right.

Positive PO contrast almost always makes a CT easier for the radiologist to read (with a few exceptions, IBD being one). Its benefit is through stuff that's not particularly metric-sensitive: slightly faster interpretation turn around time, decreased interpretation fatigue, more confident diagnoses, and occasionally it's necessary to make the right diagnosis in some patients. So those who say PO contrast is better are right.

Do these benefits outweigh the time and cost investment to make PO contrast routine for ED patients? It seems like on average the answer is no. So those against PO contrast in the ED are also right, although you can't extrapolate this out to all patients and it still makes sense in most inpatients and routine outpatients.

BTW, if your CT PO contrast is called "Tomocat" (a common brand) then it is indeed barium, but a very dilute barium. Most ED departments use a water-soluble variation of PO contrast in case there is a GI leak so you don't spill barium into the peritoneal space.

 

[meister]

Personally, I don't really agree that it "almost always" makes the scan easier to read. Maybe my area just has an above average preponderance of mesenteric fat providing enough innate contrast already.

Edit: I should add, some of the difficulty in this comes in not knowing prior to the scan being done precisely in which patients it will be helpful.

 

[Gadofosveset]

Personally, I don't really agree that it "almost always" makes the scan easier to read. Maybe my area just has an above average preponderance of mesenteric fat providing enough innate contrast already.

PO contrast rarely makes a CT of the abdomen and pelvis less easy to read.

Although the mental energy savings per study may be small (or in your case, imperceptible), I would argue that they add up... Not that this is applicable to our ED population of interest.

Another problem is that it's hard to quantify how important a change in diagnosis would be. If PO contrast theoretically changed the imaging read 2% of the time (totally made up but plausible number), that doesn't seem valuable, but are those few situations much more critically meaningful changes? Can the value of these changes even be well measured? How do you weigh uncommon critical misses against TAT? I don't know the answer to this, but going without PO in the ED seems a reasonable trade off to me between time and risk.

 

[Gadofosveset]

Another important thing to consider is the patient population coming to the ED. If they're 33% normal, then there's going to be much less benefit to the small advantage of PO contrast than if you work at a tertiary cancer center and the studies are 1% normal.

 

[deleted109597]

Are your nephrology colleagues on board with this / are you fine giving IV contrast to IVVD CKD 4/5 patient? I'm admittedly no expert of the literature here, and I last rotated through nephrology in 2016, but nephrologists seemed pretty keen on the validity of CIN as an entity, and the pathophysiology was, to my understanding, at least reasonably well investigated. The authors highlighted well the limitations of their study, though it's admittedly still fairly compelling

My nephrology colleagues wouldn't be on board if I declared the sky was blue. They demand that single doses of toradol not be used on anybody, that kayexalate is effective AND safe, and that bicarb drips are based on any shred of evidence.

Positive PO contrast almost always makes a CT easier for the radiologist to read (with a few exceptions, IBD being one). Its benefit is through stuff that's not particularly metric-sensitive: slightly faster interpretation turn around time, decreased interpretation fatigue, more confident diagnoses, and occasionally it's necessary to make the right diagnosis in some patients. So those who say PO contrast is better are right.

If you train with it, then yes. But the studies show it doesn't make that much difference if you train without it.

Do these benefits outweigh the time and cost investment to make PO contrast routine for ED patients? It seems like on average the answer is no. So those against PO contrast in the ED are also right, although you can't extrapolate this out to all patients and it still makes sense in most inpatients and routine outpatients.

We don't and aren't. I don't give two ****s about what is done for routine outpatients or inpatients, as I don't take care of that population. Nothing I say is going to apply to them.

BTW, if your CT PO contrast is called "Tomocat" (a common brand) then it is indeed barium, but a very dilute barium. Most ED departments use a water-soluble variation of PO contrast in case there is a GI leak so you don't spill barium into the peritoneal space.

I've never come across that version. Every single hospital I've worked at (n=11 in 7 states so far) has used gastrografin. But I appreciate the info.

 

[EMDOC17]

I order PO contrast when I pick up a pain in the buttocks patient <1 hr of my shift end.

 

[emergentmd]

THis is a question I had been wondering about... When do you guys order IV and oral contrast for a abdominal CT scan? In other words, when would you definitely add oral contrast? From what I understand IV contrast is sufficient for things like diverticulitis, colitis. At my shop, IV contrast ONLY is sufficient for the following:
BMI > 20
Age > 25
No history of GI tract altering surgery (e.g. gastric bypass)
No history or suspicion of inflammatory bowel disease
No abdominal or pelvic surgery within the last 30 days.

Haven't ordered PO contrast in 8+ yrs unless bariatric b/c they have a protocol.

Order IV contrast in prob 20%.

80% complete noncontrast CT and radiologist never complains. Some oldies may, but after awhile, they go with the current trend of not needing IV contrast either.

 

[TooMuchResearch]

If the patient has a perf, then they're likely going to have peritoneal signs... in which case the test of choice is an upright chest x-ray. If that's positive, then pretty much the only reason to get a CT is if it's taking too long to mobilize the OR team.

Our surgeons want to know where the hole is, CT is my test of choice.

 

[e30ftw]

If the patient has a perf, then they're likely going to have peritoneal signs... in which case the test of choice is an upright chest x-ray. If that's positive, then pretty much the only reason to get a CT is if it's taking too long to mobilize the OR team.

A large percentage of patients with a perforated hollow viscous do not have classic peritonitis. A large percentage of ED patients with acute gastroenteritis have both guarding, tachycardia, fever and nausea/vomiting, which are classic clinical manifestations of peritonitis.

If I call CT and ask an emergent scan on one of my patients, it takes maybe 5 minutes to perform and adds valuable operative information to the surgeon.

There are few reasons why a patient going to the OR for a perforated viscous should not have a CT performed. If I'm going for an ex-lap for the love of God please scan me before running bowel in the OR..

A few nights ago about this time I was on the phone with a radiologist advising him that the CXR he read as "negative" in fact showed a subtle but large PTX as well as a pulmonary mass.. He assured me he was looking at the film and that it was negative for any acute findings. The pt was stable so I scanned him before putting in a chest tube, yep, large PTX complicated by a pleural fluid collection. Radiology never even called me back to say thanks for saving his ass.. have much respect/appreciation for the work of our colleagues in radiology but that one was a bit much.

EM residents: always review your own imaging.

Also:

The evidence supports no difference between PO/IV and IV-only contrast in emergent CT of the abd/pelvis.

 

[DrBowtie]

Haven't ordered PO contrast in 8+ yrs unless bariatric b/c they have a protocol.

Order IV contrast in prob 20%.

80% complete noncontrast CT and radiologist never complains. Some oldies may, but after awhile, they go with the current trend of not needing IV contrast either.

Thankfully that hasn't caught on at our ER from a radiologists perspective. Non IV con is pretty much less sensitive and specific for any pathology except for tiny stones...and since you guys don't think CIN exists anymore then why not give IV contrast

 

[deleted109597]

Thankfully that hasn't caught on at our ER from a radiologists perspective. Non IV con is pretty much less sensitive and specific for any pathology except for tiny stones...

I mean, if only there was some data that directly contradicted this statement.
Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. - PubMed - NCBI
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Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. - PubMed - NCBI
Normal appendix in adults: reproducibility of detection with unenhanced and contrast-enhanced MDCT. - PubMed - NCBI

and since you guys think CIN doesn't exist anymore then why not give IV contrast

So, what do you make of the data that says it doesn't exist, except maybe at coronary angiogram volumes? http://www.emdocs.net/contrast-induced-nephropathy-confounding-causation/
Similarly, what is your perspective on contrast allergies?

 

[DrBowtie]

I mean, if only there was some data that directly contradicted this statement.
Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. - PubMed - NCBI
An Error Occurred Setting Your User Cookie
Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. - PubMed - NCBI
Normal appendix in adults: reproducibility of detection with unenhanced and contrast-enhanced MDCT. - PubMed - NCBI


So, what do you make of the data that says it doesn't exist, except maybe at coronary angiogram volumes? http://www.emdocs.net/contrast-induced-nephropathy-confounding-causation/
Similarly, what is your perspective on contrast allergies?

If only every scan you order is for acute appendicitis and they are only either positive for appendicitis or negative. Even in appendicitis case, the enhancement or focal lack there of can aid in dx of perforation and increases confidence in abscess formation vs phlegmon. So while your disposition to surgery may be the same, the patients management may be affected.

Again almost no abdominal pathologies can't be helped by evaluating the enhancement pattern.

Lastly this may not matter to you in the ER setting but adding contrast can help with characterization of incidentalomas which helps the pt avoid additional expense and workup.

As for CIN, the ER paper has garnered discussion for sure. Ultimately more data is needed and consensus statements from Radiology and Nephrology must be released before any real practice changes will happen from a medicolegal perspective.

The newer agents definitively cause less reactions but they do exist. The ACR contrast manual is the best resource for information on this. Part of the issue is poor documentation of prior allergies such as those with the mythical iodine allergy.

 

[GeneralVeers]

If only every scan you order is for acute appendicitis and they are only either positive for appendicitis or negative. Even in appendicitis case, the enhancement or focal lack there of can aid in dx of perforation and increases confidence in abscess formation vs phlegmon. So while your disposition to surgery may be the same, the patients management may be affected.

True, but you have to balance the small gain of giving IV contrast, with the huge hit to department flow of giving PO contrast. It would literally increase my dispo by 2 hours on every abdominal CT I order, so at least 5-6 patients per shift. That may not sound like a lot, but it's potentially 4-5 fewer patients we could move through in a shift.

 

[DrBowtie]

Also check out the ACR appropriateness criteria for the abdominal indications. These are well researched recommendations that compare the effectiveness of different modalities and technique.

With the upcoming mandatory implementation of clinical decision support I suspect your ordering patterns will be forced to conform more closely to these guidelines.

 

[DrBowtie]

True, but you have to balance the small gain of giving IV contrast, with the huge hit to department flow of giving PO contrast. It would literally increase my dispo by 2 hours on every abdominal CT I order, so at least 5-6 patients per shift. That may not sound like a lot, but it's potentially 4-5 fewer patients we could move through in a shift.

I wasn't referring to the PO contrast portion of the post I responded to. I don't care about PO unless they are recent post op GI surg or super skinny. A POC creatinine takes minutes.

Edited for clarity.

 

[Siggy]

A large percentage of patients with a perforated hollow viscous do not have classic peritonitis. A large percentage of ED patients with acute gastroenteritis have both guarding, tachycardia, fever and nausea/vomiting, which are classic clinical manifestations of peritonitis.

If I call CT and ask an emergent scan on one of my patients, it takes maybe 5 minutes to perform and adds valuable operative information to the surgeon.

There are few reasons why a patient going to the OR for a perforated viscous should not have a CT performed. If I'm going for an ex-lap for the love of God please scan me before running bowel in the OR..

What percent of the ED patients with acute gastroenteritis has air under the diaphragm?