TH5.1 The compliance and utility of Abdominal X-ray in acute general surgical admissions

Abstract

Abstract Aims Most acute surgical admissions have abdominal symptoms, with many having an Abdominal X-ray (AXR) performed. Primary aim was to audit the indication(s) of AXR against Royal College of Radiologists (RCR) iRefer guidelines. Secondary aim was to analyse the proportion of patients who had further imaging. Methods A retrospective cohort study of consecutive adult patients with acute surgical admission who had AXR in a busy tertiary hospital. The study period was from 1st October 2021 to 30th November 2021. Patient's demographics, indication for AXR and further imaging within 7 days were analysed. The indications were audited against the RCR iRefer guidelines (8th edition, 2017). Results 456 patients were included; 252 (55.3%) were female and median age was 63 years (16–96). 200 (43.9%) were performed out of hours. The indications for AXR were: perforation/obstruction 70.0%; renal stone/foreign body 17.9%, constipation 5.9%, acute exacerbation of IBD 1.3% and palpable mass 0.7%. Overall, 95.2% AXR requests were compliant with iRefer guidelines. 196 (43.0%) patients had further imaging within 7 days of admission: 164 (36.0%) had CT scan, 35 (7.7%) had abdominal and/or pelvic ultrasound and 12 (2.6%) had MRI. Conclusions The compliance with RCR iRefer guideline is very high. However, a large proportion of patients had further imaging, with over one third of patients subsequently undergoing a CT scan. We suggest that in cases where further cross sectional imaging is likely, clinicians should consider omitting AXR. This will prevent delays, reduce radiation exposure and maximise the utility of resources.