Is clinical examination alone becoming obsolete in modern surgic

Published Date: 19th July 2016

Publication Authors: Rajaganeshan R, Wellens T

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Aim

Computed Tomography (CT) is the radiological investigation of choice for the majority of acute surgical admissions with abdominal pain. Accuracy has been repeatedly reported at over 95% in studies since 2002. A retrospective analysis was performed to compare a senior clinician's bedside diagnosis with that of emergency CT.

Method

Retrospective review of 100 sequential emergency patients presenting with abdominal pain and who were felt to have pathology necessitating laparotomy was performed. Data was identified in August 2013 for the preceding time period. Data was collected using a standardised proforma and electronic records. Patients were characterised by age, gender and ASA.

Results

4 patients with incomplete data were excluded. The mean age was 63 years, with a male:female ratio 1:1. ASA was 2-3 predominantly. There was no significant difference in critical care admission. There were 14 mortalities in the elderly and 7 in the young cohort. Clinical diagnosis and operative findings at laparotomy were consistent in 57.3% (55/96) patients. Correlation between CT diagnosis and operative findings 84.4% (81/96). Clinical diagnosis was incongruent with CT findings in 42.7% (41/96) cases.

Conclusion

Our cohort of patients comprised of systemically unwell patients who can be more difficult to assess due to physiological distress. With the significantly better diagnostic capabilities of CT when compared to clinical diagnosis alone, by a senior grade surgeon, should patients be imaged as opposed to examined on arrival to the surgical unit.

Hancorn, K; Hargreaves, A; Wellens, T; Heneghan, S; Rajaganeshan, R. (2014).  Is clinical examination alone becoming obsolete in modern surgical practice?  Colorectal Disease. 16 (Supplement S2), 146-47

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