The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain
Abstract Introduction There is discord on the value of the erect abdominal radiograph for diagnosing acute abdominal pathologies. The erect radiograph can be uncomfortable for patients in pain and increases patient radiation dose. Aim To determine if including the erect abdominal radiograph in plain...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-12-01
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| Series: | Journal of Medical Radiation Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jmrs.299 |
| _version_ | 1818246341405442048 |
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| author | Wendy Z. M. Geng Michael Fuller Brooke Osborne Kerry Thoirs |
| author_facet | Wendy Z. M. Geng Michael Fuller Brooke Osborne Kerry Thoirs |
| author_sort | Wendy Z. M. Geng |
| collection | DOAJ |
| description | Abstract Introduction There is discord on the value of the erect abdominal radiograph for diagnosing acute abdominal pathologies. The erect radiograph can be uncomfortable for patients in pain and increases patient radiation dose. Aim To determine if including the erect abdominal radiograph in plain abdominal radiography (PAR) improved diagnostic accuracy for identifying mechanical bowel obstruction and/or paralytic ileus in adults presenting with acute abdominal pain. Methods PAR of 40 consecutive adults presenting with suspected bowel obstruction or paralytic ileus was retrospectively sampled and independently reviewed by two emergency department (ED) consultants and two radiology consultants for bowel obstruction and paralytic ileus across two sessions. In session 1, the assessors assessed the supine abdominal radiographs (PAR 1) and clinical details in a randomised order, and session 2, at least 6 weeks later, they assessed the supine and erect radiographs (PAR 2) and clinical details of the randomly re‐ordered cases. Computed tomography was the reference standard. Pair‐wise comparisons of receiver operating characteristic curves were calculated to assess for significant differences in participants’ diagnostic accuracy using MedCalc 16.4.3. Results Average sensitivity, specificity and area under the receiver operating characteristic curves (AUROC) were 69.7%, 61.0% and 0.642 for PAR 1, respectively, and 80.0%, 53.4% and 0.632 for PAR 2 respectively. For AUROC there were no significant differences (P > 0.05) between PAR 1 and PAR 2. Intra‐rater and inter‐rater agreement improved in PAR 2. Conclusion There was no statistically significant improvement in diagnostic accuracy when including the erect radiograph in PAR for the acute abdomen. |
| first_indexed | 2024-12-12T14:47:16Z |
| format | Article |
| id | doaj.art-32c7f52516b946068b78b08ea47f25cd |
| institution | Directory Open Access Journal |
| issn | 2051-3895 2051-3909 |
| language | English |
| last_indexed | 2024-12-12T14:47:16Z |
| publishDate | 2018-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Medical Radiation Sciences |
| spelling | doaj.art-32c7f52516b946068b78b08ea47f25cd2022-12-22T00:21:05ZengWileyJournal of Medical Radiation Sciences2051-38952051-39092018-12-0165425926610.1002/jmrs.299The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal painWendy Z. M. Geng0Michael Fuller1Brooke Osborne2Kerry Thoirs3International Centre for Allied Health Evidence University of South Australia Adelaide South Australia AustraliaInternational Centre for Allied Health Evidence University of South Australia Adelaide South Australia AustraliaInternational Centre for Allied Health Evidence University of South Australia Adelaide South Australia AustraliaInternational Centre for Allied Health Evidence University of South Australia Adelaide South Australia AustraliaAbstract Introduction There is discord on the value of the erect abdominal radiograph for diagnosing acute abdominal pathologies. The erect radiograph can be uncomfortable for patients in pain and increases patient radiation dose. Aim To determine if including the erect abdominal radiograph in plain abdominal radiography (PAR) improved diagnostic accuracy for identifying mechanical bowel obstruction and/or paralytic ileus in adults presenting with acute abdominal pain. Methods PAR of 40 consecutive adults presenting with suspected bowel obstruction or paralytic ileus was retrospectively sampled and independently reviewed by two emergency department (ED) consultants and two radiology consultants for bowel obstruction and paralytic ileus across two sessions. In session 1, the assessors assessed the supine abdominal radiographs (PAR 1) and clinical details in a randomised order, and session 2, at least 6 weeks later, they assessed the supine and erect radiographs (PAR 2) and clinical details of the randomly re‐ordered cases. Computed tomography was the reference standard. Pair‐wise comparisons of receiver operating characteristic curves were calculated to assess for significant differences in participants’ diagnostic accuracy using MedCalc 16.4.3. Results Average sensitivity, specificity and area under the receiver operating characteristic curves (AUROC) were 69.7%, 61.0% and 0.642 for PAR 1, respectively, and 80.0%, 53.4% and 0.632 for PAR 2 respectively. For AUROC there were no significant differences (P > 0.05) between PAR 1 and PAR 2. Intra‐rater and inter‐rater agreement improved in PAR 2. Conclusion There was no statistically significant improvement in diagnostic accuracy when including the erect radiograph in PAR for the acute abdomen.https://doi.org/10.1002/jmrs.299Abdomenacutediagnostic x‐rayileusintestinal obstructionsensitivity and specificity |
| spellingShingle | Wendy Z. M. Geng Michael Fuller Brooke Osborne Kerry Thoirs The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain Journal of Medical Radiation Sciences Abdomen acute diagnostic x‐ray ileus intestinal obstruction sensitivity and specificity |
| title | The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| title_full | The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| title_fullStr | The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| title_full_unstemmed | The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| title_short | The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| title_sort | value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain |
| topic | Abdomen acute diagnostic x‐ray ileus intestinal obstruction sensitivity and specificity |
| url | https://doi.org/10.1002/jmrs.299 |
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