Should chest computed tomography be routine in patients referred to abdominal computed tomography for major emergency...

The introduction of optimised care bundles in emergency major abdominal surgery has reduced mortality. Core elements are fast diagnostic work-up with abdominal computed tomography (CT) and surgery without delay. Given the diagnostic challenges in patients with abdominal pain, we aimed to investigate if the addition of a full contrast-enhanced chest CT provides additional clinically significant diagnostic information in patients referred to an emergency abdominal CT.

This retrospective cohort study included patients with suspected major abdominal pathology referred to an emergency abdominal CT with complementary chest CT (extended CT) from 1 April 2020 to 9 September 2020. This population was compared to a historic cohort with a regular emergency abdominal CT. The primary outcome was chest CT findings leading to treatment or intervention during index admission.

A total of 187 patients were scanned in the study period and compared to 170 historic controls. The two groups were comparable. The extended CT group had more clinically significant chest findings 28 (15.0%) compared to the standard group 9 (5.3%) (p = 0.002), of which pneumonia was found 18 versus 3 times, respectively. The extended CT group had more suspicious findings 22 versus 7 (p = 0.008) but did not result in significantly more out-patient referrals (8 versus 4, p = 0.38).

In patients with suspected major abdominal pathology, an extended CT protocol which includes a full chest CT provides additional diagnostic information without reducing mortality.