ArticleEmergency radiology2026
Diagnostic utility of abdominal radiography in emergency departments with high guideline compliance: a retrospective cohort study.
Article in Emergency radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAbdominal radiography (AXR) remains widely used in emergency departments (EDs) despite concerns about diagnostic performance, often attributed to inappropriate use. We evaluated appropriateness, diagnostic yield and 48-hour abdominopelvic CT utilisation in two Scottish EDs with high Royal College of Radiologists (RCR) iRefer adherence.
methodsRetrospective multi-centre cohort study of 866 adults (median age 65 years, 49.5% female) undergoing AXR during ED attendance at two Scottish acute hospitals in 2024. Requests were classified against RCR iRefer (2017) criteria. Primary outcomes were RCR compliance and CT utilisation within 48 h; secondary outcomes were AXR yield by compliance, CT positivity by AXR result, AXR-CT concordance, and disposition.
resultsRCR compliance was 88.3%. Despite this, 67.9% of AXRs were normal and 35.6% of patients underwent CT within 48 h. Among patients proceeding to CT, clinically significant pathology was identified after 80.0% (136/170) of normal and 95.7% (132/138) of abnormal AXRs. Compliant requests had higher AXR yield (33.6% vs. 20.8%, p = 0.01) but compliance did not predict CT utilisation (p = 0.67). CT provided discordant or additive information beyond AXR in 12.7% and 28.6% of paired examinations, respectively. Of patients undergoing CT, 98.1% were admitted irrespective of result.
conclusionsExemplary guideline adherence did not overcome AXR's diagnostic limitations. A normal AXR did not exclude significant pathology, and abnormal AXRs frequently required CT for characterisation. These findings support prospective evaluation of direct-to-CT pathways for selected acute abdominal presentations, including patient-safety, workflow and economic outcomes.
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