Objective

Computed tomography (CT) imaging is frequently obtained for recurrent abdominal pain after a prior emergency department (ED) evaluation. We evaluate the utility of repeat CT imaging following an indeterminate index CT in low-risk abdominal pain adult ED patients.

Methods

An electronic search was designed for the Patient-Intervention-Control-Outcome-Timing (PICOT) question: (P) adult patients with low- risk, recurrent and previously undifferentiated atraumatic abdominal pain presenting to the ED after an index negative CT within 12-months, (I) repeat CT versus (C) no repeat CT, for (O) abdominal surgery or other invasive procedure, mortality, identification of potentially life-threatening diagnosis, hospital and ICU admission rates, return ED visit (T) all within 30-days. Four reviewers independently selected evidence for inclusion and then synthesized the results around the most prevalent themes of repeat CT timing, diagnostic yield, ionizing radiation exposure, and predictors of repetitive imaging.

Results

Although 637 manuscripts and abstracts were identified, no direct evidence was found. Thirteen documents were synthesized as indirect evidence. None of the indirect evidence defined a low-risk subset of abdominal pain, nor did investigators describe whether re-imaging occurred for complaints similar to the initial ED evaluation. Included studies did not describe the index CT findings and some reported explanatory findings noted on the original CT for which repeat CTs might have been indicated. The timeframe for a repeat CT ranged from hours to one year. The frequency of repeat CTs (2-47%) varied across studies as did the yield of imaging to alter downstream clinical decision-making (range 5-67%).

Conclusion

Due to the absence of direct evidence our scoping review is unable to provide high-quality evidence-based recommendations upon which to confidently base an imaging practice guideline. There is no evidence to support or refute performing a CT for low-risk recurrent abdominal pain.