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The barium enema; evidence for proper utilization.
Radiology
|February 1, 1979
Summary
Selecting patients for barium enemas based solely on specific disease indicators could miss 10% of gastrointestinal disease cases. This highlights the need for careful consideration of clinical symptoms alongside diagnostic indicators for accurate large bowel disease detection.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
Background:
- Barium enemas are a common diagnostic tool for large bowel disease.
- Identifying optimal patient selection criteria can improve diagnostic yield and resource allocation.
Purpose of the Study:
- To identify symptoms, signs, or laboratory findings associated with high or low yield of abnormal barium enemas.
- To evaluate the impact of selecting patients based on statistically significant or clinically important indicators.
Main Methods:
- Retrospective analysis of 1,041 patient cases undergoing barium enema.
- Statistical analysis to identify significant indicators of large bowel disease.
Main Results:
- Eliminating examinations based solely on statistically significant indicators (fever, positive stool benzidine, mass, low hematocrit) or clinical indicators (weight loss, altered bowel habits) would reduce examinations by 13%.
- However, this selective approach would result in missing 10% of patients with actual gastrointestinal disease.
Conclusions:
- Strict adherence to statistically significant or clinically important indicators for barium enema may lead to underdiagnosis.
- A balance between diagnostic indicators and clinical judgment is crucial for effective large bowel disease screening.