ASSESSMENT OF REFERRING CLINICIAN'S ADHERENCE TO ROYAL COLLEGE OF RADIOLOGISTS GUIDELINES FOR ABDOMINAL RADIOGRAPHY

Abstract

Introduction: One of the commonest complaints encountered in the emergency department is acute abdominal pain and the most common investigation ordered to evaluate it is an abdominal X-ray (AXR). However many studies have shown that AXR has a low diagnostic yield and this investigation may be overused. So in order to optimize the sensitivity of AXR, the Royal College of Radiologists (RCR) introduced the iRefer guidelines. Aims: This study aims to assess referring clinicians' adherence to iRefer guidelines for abdominal radiography. And to determine whether the professional status of the referring clinician inuences their adherence to the guideline. Methodology: This is a retrospective study of consecutive adult patients, who presented to a rural tertiary care center between October 2020 and March 2021. Indications for AXR and clinician seniority were determined from the radiology request slips. The appropriateness of imaging was determined by comparing the indication for abdominal radiographs to iRefer guidelines by the Royal College of Radiology. Data was then analyzed accordingly. Results: Our study included 100 patients. 22% of abdominal radiographs were requested according to the iRefer guidelines while 78% were against the guidelines (p-Value = 0.0001). Out of 22 radiographs adhering to iRefer Guidelines, 7 radiographs were normal and 15 were abnormal (14 correct and 1 incorrect in comparison to gold standard). Also, out of 78 radiographs not adhering to the guidelines, 59 radiographs were normal and 19 were abnormal (5 correct and 14 incorrect). Conclusion: The accuracy of detected abnormalities, if we adhere to iRefer guidelines, is 93%. Therefore, we need to follow the iRefer guidelines for every abdominal X-ray. Non-adherence to iRefer guidelines leads to unnecessary exposure of a patient to radiation and increased cost of treatment. To improve the patient's management we need to educate and inform the doctors of different levels about the guidelines.