Delays in imaging diagnosis of acute abdominal pain in the emergency setting

Acute abdominal pain is a common cause of ED visits and often requires imaging to identify a specific diagnosis. Prompt and appropriate imaging plays a crucial role in patient management and leads to improved patient outcomes, decreased hospital stay, and improved ED workflow. There are many cases of abdominal pain in the ED with delayed diagnosis and management secondary to a combination of institutional policies and knowledge deficits in current imaging guidelines. Inappropriate use of abdominal radiographs, use of oral contrast for CT abdomen and pelvis, and concern for iodinated contrast-induced acute kidney injury are three of the more commonly encountered roadblocks to prompt imaging diagnosis of abdominal pain. The purpose of this review is to discuss why these potential causes of delayed diagnosis occur and how radiologists can help improve both imaging and ED workflow by utilizing the most up-to-date imaging guidelines such the American College of Radiology (ACR) Appropriateness Criteria and ACR Manual on Contrast Media to assist clinicians working in the emergency setting. •Prompt radiology evaluation of acute nontraumatic abdominal pain leads to improved patient outcomes•Abdominal radiographs are less accurate than CT in diagnosing common causes of acute abdominal pain•Oral contrast does not provide significant diagnostic benefit to CT abdomen and pelvis but takes longer to perform•Contrast-induced acute kidney injury risk is overestimated due to results from outdated research studies•Reviewing up to date imaging and contrast guidelines can help limit delays in ordering the proper imaging study