The evaluation of compliance with iRefer guidelines for abdominal imaging and the impact of the normal abdominal radiograph on the clinical confidence and decision making of emergency clinicians

Abstract

Introduction: Attendance of adult patients to the Emergency Department (ED) with acute abdominal pain is a frequent event. Abdominal X-ray imaging (AXR) is commonly the first line of investigation but previous studies have suggested that the AXR has no place in assessing acute abdominal pain because of its low diagnostic yield and limited contribution to direct clinical decision making. However, no evaluation of the impact of a negative AXR on the clinical confidence and decision making of emergency clinicians has been undertaken. This study aims to fill this gap. Method: A self-designed paper questionnaire was distributed to medical clinicians on ED placement at a single NHS trust in the South of England. The survey sought to explore the impact of the negative AXR on clinical confidence and decision making and compliance with iRefer guidelines for referring to alter-native imaging modalities (ultrasound and computed tomography) should the option to refer for AXR be restricted. Results: A total of 28 (n¼28/41; 68.3%) completed questionnaires were returned. Most clinicians(n¼18/28; 64.3%) indicated that negative AXR had little impact on their clinical decision making although a small majority (n¼10/18; 55.6%) acknowledged it provided greater clinical confidence in their decision making. Variable compliance with iRefer guidelines for referral to ultrasound and computed tomography was noted. Conclusion: Whilst the negative AXR did not impact on the clinical decision making of most ED clinicians,it did increase clinical confidence. Consequently, the AXR should remain a referral option in the workup for adult patients presenting with acute abdominal pain to the emergency department.