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Utility of the Plain Abdominal Roentgenogram

Anand Mutgi, MD; John W. Williams, MD; Mary Nettleman, MD

Arch Intern Med. 1991;151(8):1589-1592.

Abstract
We conducted a retrospective cohort study of 85 consecutive symptomatic patients to evaluate the sensitivity, specificity, and predictive value of plain abdominal roentgenography (PAR) compared with clinical evaluation alone in diagnosis and treatment of renal colic. With a positive intravenous pyelogram and/or actual stone retrieval used as the gold standard, 72 patients had documented stones. The calculated sensitivity and specificity for PAR were 58% (95% confidence interval, 47% to 69%) and 69% (95% confidence interval, 44% to 94%), respectively. In this population with a stone prevalence of 85%, the positive predictive value of PAR was 91%. A clinical scoring system based on signs and symptoms fared as well as PAR (sensitivity, 73%; specificity, 46%; and positive predictive value, 88%). The strategy of clinical scoring followed by selective use of intravenous pyelography was more cost-effective than strategies using PAR. We conclude that the PAR has low sensitivity and specificity and improves the predictive value only marginally, and its routine use is not costeffective.

(Arch Intern Med. 1991;151:1589-1592)

Author Affiliations
From the Division of General Internal Medicine, Department of Medicine, Medical College of Ohio, Toledo (Dr Mutgi); Department of Internal Medicine, Duke University, Durham, NC (Dr Williams); and Division of General Medicine, Clinical Epidemiology, and Health Services Research, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (Dr Nettleman). Dr Nettleman is a Henry J. Kaiser Family Foundation Scholar in General Internal Medicine.

Footnotes
Accepted for publication February 15, 1991.

Presented in part at the national meeting of the Society of General Internal Medicine, Washington, DC, April 29, 1988.

Reprint requests to Department of Internal Medicine, Medical College of Ohio, PO Box 10008, Toledo, OH 43699 (Dr Mutgi).

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