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Abdominal Cross-sectional Imaging for Inpatients With Abnormal Liver Function Test Results
Yield and Usefulness
Jeffrey M. Rothschild, MD, MPH;
Ramin Khorasani, MDCM, FRCPC;
Stuart G. Silverman, MD;
Richard W. Hanson;
Julie M. Fiskio;
David W. Bates, MD, MSc
Arch Intern Med. 2001;161:583-588.
Background Abdominal cross-sectional imaging is often performed to evaluate abnormal
liver function test (LFT) results in hospitalized patients. However, few data
are available regarding the yield and usefulness of imaging inpatients for
the indication of abnormal LFT results, the process of requesting abdominal
imaging studies, or the response to their findings.
Methods We retrospectively reviewed abdominal imaging scans that were obtained
during a 27-month period. We matched the imaging studies done with the indication
of abnormal LFT results; all scans were requested using computerized physician
order entry. Reports were coded for interpretation and associated process
step results. To determine the usefulness of the imaging studies, a random
sample of patient charts with positively coded imaging studies were reviewed.
Imaging examinations were considered useful if they provided new diagnostic
information and/or changed subsequent patient care.
Results Of 6494 abdominal imaging studies, 856 were performed for the indication
of abnormal LFT results and matched to both image reports and laboratory results.
Report coding judged 37% of interpretations as clinically significant, including
27% with "positive" (abnormal results and explain the abnormal LFT results)
examinations. Among the positive examinations, the most common diagnoses were
biliary obstruction (25%), cholecystitis (21%), malignancy (20%), and cirrhosis
(14%). Positively coded reports provided new clinical information in 63% of
these studies and changed patient care in 42% of cases. Process measures assessed
provision of additional information to and from radiologists (69% and 8%,
respectively) and the frequency with which the findings of current abdominal
imaging studies were compared with those of prior studies (59%).
Conclusion Abdominal cross-sectional imaging studies performed on inpatients with
abnormal LFT results had a high diagnostic yield and frequently changed patient
care.
From the Division of General Medicine (Drs Rothschild and Bates) and
the Department of Radiology (Drs Khorasani and Silverman and Mr Hanson), Brigham
and Women's Hospital, the Departments of Medicine (Drs Rothschild and Bates)
and Radiology (Drs Khorasani and Silverman), Harvard Medical School, and Clinical
Information Systems, Partners Healthcare System (Ms Fiskio), Boston Mass.
Corresponding author: Jeffrey M. Rothschild, MD, MPH, Division of
General Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA
02115.
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