Changes of Clinical Practice in Gastrointestinal Perforation with the Increasing Use of Computed Tomography

Park,  Ji Min; Yoon,  Young Hoon; Horeczko,  Timothy; Kaji,  Amy Hideko; Lewis,  Roger J

doi:2017.30.2.25

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Original Article

Journal of Trauma and Injury 2017;30(2):25-32.
DOI: https://doi.org/10.20408/jti.2017.30.2.25 Published online June 30, 2017.

Changes of Clinical Practice in Gastrointestinal Perforation with the Increasing Use of Computed Tomography

Ji Min Park, Young Hoon Yoon, Timothy Horeczko, Amy Hideko Kaji, Roger J Lewis

¹Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea. yyh71346@naver.com
²Harbor-UCLA Medical Center, Torrance, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA, and the Los Angeles Biomedical Research Institute, Torrance, CA.

Received: 17 December 2016 • Revised: 30 December 2016 • Accepted: 30 December 2016

Abstract

PURPOSE
The use of computed tomography (CT) to evaluate acute abdominal complaints has increased over the past two decades. We investigated how the clinical practice of patients with intestinal perforation has changed with the increasing use of abdominal CT in the emergency department (ED).
METHODS
We compared ED arrival to CT time, ED arrival to surgical consultation time, and ED arrival to operation time according to the method of diagnosis from 2003?2004 and 2013?2014.
RESULTS
In patients with gastrointestinal perforation, time from ED arrival to CT was shorter (111.4±66.2 min vs. 199.0±97.5 min, p=0.001) but time to surgical consultation was longer (135.1±78.8 vs. 77.9±123.7, p=0.006) in 2013?2014 than in 2003?2004. There was no statistically significant difference in time to operation for perforation confirmed either by plain film or CT between the two time periods. There was no statistically significant difference in length of hospital or ICU stay or mortality between the two groups.
CONCLUSION
With the increasing use of abdominal CT in ED, ED arrival to CT time has decreased and ED arrival to surgical consultation time has increased in gastrointestinal perforation. These changes of clinical performance do not delay ED arrival to operation time or adversely influence patient outcome.

Key Words: Gastrointestinal perforation; Computed tomography; Clinical performance

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