AB119. SOH23ABS_047. Plain film abdomens, more harm than good?

Background: A plain film abdomen (PFA) contributes minimally to clinical scenarios due to low sensitivity and specificity. The use of PFA exposes patients to unnecessary radiation and is a drain on hospital financial resources. We hypothesise that PFAs in the emergency department are over utilised to falsely reassure clinicians and patients alike.

Methods: A search of the National Integrated Medical Imaging System (NIMIS) database in University Hospital Waterford was conducted to identify all PFAs requested by the emergency department between 01/01/2022 and 31/07/2022. Requests for patients over 40 years of age or where was suspicion of foreign body ingestion were excluded. A retrospective search of the NIMIS database was used to identify if patients underwent further imaging post PFA.

Results: A total of 85 PFAs were deemed suitable for inclusion. These comprised of 35 male and 50 female subjects. Subjects had an average age of 29.3 years. A proportion of 75% of PFAs detected no abnormality. Faecal loading and dilated bowel loops were the only pathologies identified on plain film. None of the patients with pathology on PFA underwent subsequent radiological investigations. A proportion of 21% of subjects had computed tomography (CT) of their abdomen and pelvis and 14% had a formal departmental ultrasound abdomen. None of the diagnoses made by CT or ultrasound were evident on PFA.

Conclusions: PFA requests are over utilised in the emergency department. PFAs contribute remarkably little to establishing a diagnosis. PFAs are an unnecessary financial burden and are a source of needless radiation exposure

Keywords: Abdomen; emergency; misdiagnosis; radiation; X-ray