Aim: To assess the need for surgical treatment in patients with acute abdominal pain in a prospective randomized study.
Patients and methods: Initially 203 patients with acute abdominal pain were randomized to the routine abdominal computed tomography CT (rCT, n=118), or selective abdominal CT group (sCT, n=85) over a period of 16 months. Ninety-three of the randomized patients (45.8%) underwent the study design and were reached for follow-up at three months.
Results: Diagnostic accuracy improved significantly in the rCT group (p<0.001). The surgeon's assessment of the need for surgery changed more often in the rCT group than in the sCT group (78.7% vs. 46.9%, p=0.002). The confidence to treat operatively increased significantly in the rCT vs. the sCT group (65.6% vs. 40.6%, p=0.028). The rCT was the only independent parameter for the change of the assessment of surgery.
Conclusion: Routine CT allows for more confidence in decision making for the surgical treatment of patients with acute abdominal pain.
Keywords: Acute abdomen; decision making; diagnostic accuracy; need for surgery; randomized controlled study; routine CT; selective CT.