Development and implementation of an appropriateness guideline for use of CT in cases of suspected intraabdominal abscess

Rationale and Objectives, The purpose of this study was to develop an evidence-based guideline for use of computed tomography (CT) in the evaluation of suspected abdominal abscess. The goal of the guidelines was to decrease the absolute number of CT examinations performed for suspected abdominal abscess and to increase the rate of positive CT examinations while not missing clinically relevant abscesses. Materials and Methods, A multidisciplinary team developed an evidence-based guideline regarding use of CT to evaluate for suspected abscess. A control group consisted of patients scanned for suspected abscess during a 6-month period. The intervention group consisted of patients scanned in the 6 months after guideline implementation. Focal fluid collections depicted on CT scans were reviewed for both patient groups to determine if these collections were abscesses. The number and proportion of abscesses in each group were then compared. Results, During the control period, 263 CT examinations for suspected abscess were performed, 75 of which (28.5%; 90% confidence interval [CI], 24%, 33%) depicted focal fluid and 25 of which (9.5%; 90% CI, 7%, 12%) depicted abscess. During the intervention period, 238 CT examinations were performed, 54 of which (22.7%; 90% CT, 18%, 27%) depicted fluid and 41 of which (17.2%; 90% CI, 13%, 21%) depicted abscess. Conclusion, A guideline was successful at decreasing the number of CT examinations and increasing the proportion of positive CT results fur abdominal abscess. As with other inpatient utilization interventions, each practice must assess the cost-benefit trade-off of guideline implementation in complex clinical situations.