Correlation of Location of Abdominal Tenderness With Acute CT Abnormalities in Emergency Department Patients

Study Overview
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Brief Summary
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To determine the correlation between the region of abdominal tenderness determined by the examining physician and the location of acute pathology diagnosed on abdominal CT. We hypothesize that the acute pathology diagnosed by CT will lie within the region marked on the abdominal wall by the examining physician prior to CT.

Official Title
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Correlation of Location of Abdominal Tenderness With Acute CT Abnormalities in Emergency Department Patients

Conditions
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Abdominal Pain

Intervention / Treatment
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* Device: radio-opaque adhesive skin markers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All consecutive emergency department patients undergoing abdominal CT for non-traumatic abdominal pain and tenderness will be prospectively enrolled, with the following exceptions. For study purposes, abdominal pain and tenderness is defined as pain and tenderness to direct palpation in the region anterior to the mid-axillary line bilaterally, and extending from the costal margins to the inguinal ligaments. Consequently, patients undergoing CT for indications such as isolated vomiting, fever without source, staging of malignancies, isolated flank pain or suspected renal colic, or other indications that do not meet the above definition will not be enrolled. Exclusion Criteria: Pregnant women do not routinely undergo abdominal CT due to radiation concerns and will be excluded from the study. Patients with altered mental status or altered abdominal sensation (due to neurological conditions such as paraplegia) that may prevent assessment of the location of abdominal tenderness will be excluded. Preverbal children will be excluded as they rarely undergo CT and will be unable to indicate the region of maximal tenderness.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1<br>All consecutive emergency department patients undergoing abdominal CT for non-traumatic abdominal pain and tenderness will be prospectively enrolled, except for those meeting pre-specified exclusion criteria. | Device: radio-opaque adhesive skin markers<br>* The examining physician will place a radio-opaque skin marker (Beekley Corporation, Ortho-SPOTS® Order Code 187; 6mm spherical markers) at the point of maximal tenderness to direct abdominal palpation indicated by the patient. Additional markers will be placed at the cephalad and caudad limits of the region of tenderness, defined as the point at which the patient no longer complains of direct tenderness to palpation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sensitivity and specificity of a hypothetical limited CT restricted to the region of abdominal tenderness for detection of acute pathology on CT on the entire abdomen. |  | immediate | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the percentage decrease in radiation exposure which could be achieved by performing a CT restricted to the region of abdominal tenderness, compared with CT of the entire abdomen |  | immediate | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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emergency, acute, nontraumatic, abdominal pain, tenderness, CT scan, radiation, diagnosis