Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings.

Area of Science:

• Radiology
• Primary Care Medicine
• Medical Decision Making

Background:

• Primary care physicians (PCPs) often manage patients with non-specific symptoms like abdominal pain, hematuria, and weight loss.
• Computed tomography (CT) is a common imaging modality used to evaluate these symptoms.
• The impact of CT results on PCP decision-making requires further elucidation.

Purpose of the Study:

• To determine the effect of computed tomography (CT) results on physician decision making in three common clinical scenarios in primary care.
• To assess changes in leading diagnoses, diagnostic confidence, and management plans following CT evaluation.
• To evaluate the utility of CT in confirming or excluding rule-out diagnoses.

Main Methods:

• Prospective, multicenter observational study involving 91 primary care providers (PCPs) and 373 outpatients.
• PCPs completed pre- and post-CT surveys detailing diagnoses, confidence levels, and management plans.
• Study measures included changes in leading diagnoses, management strategies (including referrals and ED transfers), and diagnostic confidence.

Main Results:

• CT results led to changes in leading diagnoses in 49%-57% of patients across the evaluated conditions.
• Management plans were altered in 27%-54% of patients post-CT.
• Median diagnostic confidence significantly increased by 19%-20% (P ≤ .001), with post-CT confidence levels ranging from 80%-90%.

Conclusions:

• Computed tomography (CT) significantly influences primary care physician diagnoses and management decisions for patients presenting with abdominal pain, hematuria, or weight loss.
• CT imaging substantially enhances PCP diagnostic confidence.
• CT plays a crucial role in confirming or excluding diagnoses, thereby guiding patient care pathways effectively.