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Open Access Study protocol

Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

Wytze Laméris12, Adrienne van Randen12, Marcel GW Dijkgraaf3, Patrick MM Bossuyt3, Jaap Stoker2 and Marja A Boermeester1*

Author affiliations

1 Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands

2 Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands

3 Department of Clinical Epidemiology Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands

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Citation and License

BMC Emergency Medicine 2007, 7:9  doi:10.1186/1471-227X-7-9

Published: 6 August 2007

Abstract

Background

The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED.

Methods/design

Thousand consecutive patients with abdominal pain > 2 hours and < 5 days will be enrolled in this multicentre trial. After clinical history, physical and laboratory examination all patients will undergo a diagnostic imaging protocol, consisting of plain X-ray (upright chest and supine abdomen), US and CT. The reference standard will be a post hoc assignment of the final diagnosis by an expert panel. The focus of the analysis will be on the added value of the imaging modalities over history and clinical examination, relative to the incremental costs.

Discussion

This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain.