Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting

Ann R Coll Surg Engl. 2006 May;88(3):270-4. doi: 10.1308/003588406X98586.


Introduction: The biannual turnover of house surgeons has long been dreaded by paramedical staff because of fears of increased workloads generated by 'untrained' junior doctors. The aim of this study was to address this issue by examining both the quantity and quality of requests made for emergency abdominal radiographs made by 'experienced' house surgeons during the month of July and by the 'novices' during August.

Patients and methods: All adult patients undergoing abdominal radiography (AXR) following admission as emergencies via the surgical directorate with abdominal signs were identified prospectively. The reports of the AXRs were reviewed to determine the total number of requests and the number of positive findings for the two groups. In addition, the hand-written request forms were recovered to determine the suitability of the requests according to nationally-accepted guidelines produced by the Royal College of Radiologists (RCR).

Results: During the study period, a total of 252 radiographs were performed consisting of 98 in July and 154 in August. The number of unreported films in each month were similar at 11 (11.2%) and 16 (10.4%), respectively, leaving 87 reported radiographs in July and 138 in August. There was no difference in the number of radiographs with positive findings (excluding degenerative spinal disease) for July (n = 19; 22%) and August (n = 33; 24%). Of the 225 reported films, RCR guidelines were followed in only 73 (32%) of 225 cases. When guidelines were adhered to, positive findings were identified in 56 (76.7%) of 73 cases whereas when guidelines were not followed positive findings were seen in only 13/139 (8.9%) of AXRs.

Conclusions: We have demonstrated that the popular myth of the 'August syndrome' is unsubstantiated at least using the surrogate marker of abdominal radiograph requests. The worrying finding of a high number of unacceptable indications for the performance of abdominal radiographs deserves urgent attention both in terms of its financial implications and with regards reducing radiation exposure. A programme of education is proposed to emphasise the RCR guidelines with re-audit to assess adherence to the guidelines.

MeSH terms

  • Abdominal Pain / diagnostic imaging*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Emergency Service, Hospital / statistics & numerical data
  • Emergency Service, Hospital / trends
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Medical Staff, Hospital / standards
  • Medical Staff, Hospital / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / trends
  • Prospective Studies
  • Radiography, Abdominal / statistics & numerical data
  • Radiography, Abdominal / trends*