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Unenhanced CT 30 Percent Less Accurate Than Enhanced for ED Evaluation

Findings seen for adults presenting to the emergency department for abdominal pain

By Lori Solomon HealthDay Reporter

WEDNESDAY, May 24, 2023 (HealthDay News) — Unenhanced computed tomography (CT) is 30 percent less accurate than contrast-enhanced CT for evaluating abdominal pain in the emergency department, according to a study published online May 3 in JAMA Surgery.

Hiram Shaish, M.D., from Columbia University in New York City, and colleagues examined the diagnostic accuracy of unenhanced CT in patients admitted to an emergency department with acute abdominal pain. The analysis included 201 consecutive adult emergency department patients who underwent dual-energy contrast-enhanced CT for the evaluation of acute abdominal pain (April 1 to 22, 2017).

The researchers found that the overall accuracy of unenhanced CT was 70 percent (faculty, 68 to 74 percent; residents, 69 to 70 percent). For primary diagnoses, faculty had higher accuracy than residents (82 versus 76 percent; adjusted odds ratio, 1.83), but they had lower accuracy for actionable secondary diagnoses (87 versus 90 percent; odds ratio, 0.57). This difference was driven by faculty making fewer false-negative primary diagnoses (38 versus 62 percent; odds ratio, 0.23) but more false-positive actionable secondary diagnoses (63 versus 37 percent; odds ratio, 2.11). For overall accuracy, interrater agreement was moderate (Gwet agreement coefficient, 0.58).

“Unenhanced CT was approximately 30 percent less accurate than contrast-enhanced CT for evaluating abdominal pain in the emergency department,” the authors write. “This should be balanced with the risk of administering contrast material to patients with risk factors for kidney injury or hypersensitivity reaction.”

Two authors disclosed ties to the imaging technology industry.

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