{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T11:57:27Z","timestamp":1758369447633,"version":"3.44.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the rate of concordance between computed tomography of the abdomen and pelvis (CTAP) results and an emergency medicine (EM) provider\u2019s gestalt of obtaining an actionable CTAP result.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this prospective study, we recruited EM providers to complete questionnaires after ordering CTAP scans for patients during ED encounters. Participants recorded whether they anticipated an actionable result and the confidence level of their suspicion. We determined whether the CTAP was actionable or nonactionable based on the radiology report or actions of the treatment team. The primary outcome was how frequently CTAP results matched an EM provider\u2019s suspicion of obtaining an actionable CTAP finding. Secondary outcomes were the difference in concordance rates between the attending and learner cohorts, along with the effect of confidence on the performance of gestalt.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We analyzed 219 questionnaires, 110 from the attending group and 109 from the learner group. For the primary outcome, the relationship between EM provider gestalt and actionable CTAP results was statistically significant (P\u2009&amp;lt;\u2009.001) as 60% of respondents obtained a CTAP result that matched their clinical suspicion. Gestalt was 81% sensitive and 44% specific for actionable CTAP findings in our sample. For the secondary outcomes, learners outperformed attendings in predicting CTAP results (P\u2009&amp;lt;\u2009.001) but attendings missed fewer actionable results than learners. Participants recorded higher confidence levels when suspecting an actionable result compared to a non-actionable result (P\u2009&amp;lt;\u2009.001), but confidence did not affect the likelihood of gestalt achieving concordance with CTAP findings (P\u2009&amp;gt;\u2009.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study demonstrated that the diagnostic accuracy of an EM providers\u2019 gestalt was not clinically sufficient for actionable or non-actionable CTAP results in ED patients with abdominopelvic complaints despite a significant association between gestalt and CTAP findings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf158","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T05:29:37Z","timestamp":1744867777000},"page":"274-280","source":"Crossref","is-referenced-by-count":0,"title":["Computed Tomography of the Abdomen and Pelvis Ordering in the Emergency Department: A Prospective Analysis of Provider Gestalt"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9146-1715","authenticated-orcid":false,"given":"Michael D","family":"Gianelle","sequence":"first","affiliation":[{"name":"Emergency Department, Brooke Army Medical Center , 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston 78234, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seth","family":"Brown","sequence":"additional","affiliation":[{"name":"Emergency Department, Brooke Army Medical Center , 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston 78234, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6737-8345","authenticated-orcid":false,"given":"Rachel","family":"Robeck","sequence":"additional","affiliation":[{"name":"Emergency Department, Brooke Army Medical Center , 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston 78234, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-0822","authenticated-orcid":false,"given":"Darron","family":"Fritz","sequence":"additional","affiliation":[{"name":"Emergency Department, Brooke Army Medical Center , 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston 78234, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"issue":"6","key":"2025092002193093600_R1","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.jemermed.2015.06.062","article-title":"Efficacy of noncontrast computed tomography of the abdomen and pelvis for evaluating nontraumatic acute abdominal pain in the emergency department","volume":"49","author":"Payor","year":"2015","journal-title":"J Emerg Med"},{"issue":"1","key":"2025092002193093600_R2","doi-asserted-by":"publisher","first-page":"32","DOI":"10.21276\/ajmrr.2019.7.1.8","article-title":"Utility of computed tomography of abdomen and pelvis in cases of intestinal obstruction","volume":"7","author":"Swaroop","year":"2019","journal-title":"Asian J Med Res"},{"issue":"7","key":"2025092002193093600_R3","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1111\/acem.12698","article-title":"Abdominal computed tomography utilization and 30-day revisitation in Emergency Department Patients Presenting with Abdominal Pain","volume":"22","author":"Patterson","year":"2015","journal-title":"Acad Emerg Med"},{"key":"2025092002193093600_R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.radphyschem.2019.108438","article-title":"Estimation of effective dose and organ cancer risk from paediatric computed tomography thorax \u2013 Abdomen - Pelvis examinations","volume":"165","author":"Muhammad","year":"2019","journal-title":"Radiat Phys Chem"},{"issue":"6","key":"2025092002193093600_R5","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1111\/1475-6773.12293","article-title":"Using Medical claims for policy effectiveness surveillance: reimbursement and utilization of abdomen\/pelvis computed tomography scans","volume":"50","author":"Horny","year":"2015","journal-title":"Health Serv Res"},{"issue":"6","key":"2025092002193093600_R6","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/j.jemermed.2017.08.036","article-title":"Low yield of clinically significant injury with head-to-pelvis computed tomography in blunt trauma evaluation","volume":"53","author":"Murphy","year":"2017","journal-title":"J Emerg Med"},{"issue":"1","key":"2025092002193093600_R7","doi-asserted-by":"publisher","first-page":"e187","DOI":"10.5114\/pjr.2022.115126","article-title":"Are we overusing abdominal computed tomography scans in young patients referred in an emergency for acute abdominal pain?","volume":"87","author":"Salerno","year":"2022","journal-title":"Pol J Radiol"},{"issue":"03","key":"2025092002193093600_R8","doi-asserted-by":"publisher","first-page":"167","DOI":"10.2310\/8000.2012.120914","article-title":"Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician","volume":"15","author":"Epstein","year":"2013","journal-title":"CJEM"},{"issue":"1","key":"2025092002193093600_R9","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ajem.2017.07.042","article-title":"Role of clinical suspicion in pediatric blunt trauma patients with severe mechanisms of injury","volume":"36","author":"Garcia","year":"2018","journal-title":"Am J Emerg Med"},{"issue":"4","key":"2025092002193093600_R10","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/j.amjsurg.2019.07.010","article-title":"Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?","volume":"218","author":"Foster","year":"2019","journal-title":"Am J Surg"},{"issue":"9","key":"2025092002193093600_R11","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/j.ajem.2017.03.048","article-title":"Whole body CT versus selective radiological imaging strategy in trauma: an evidence-based clinical review","volume":"35","author":"Long","year":"2017","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2025092002193093600_R12","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.amjsurg.2020.01.006","article-title":"An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients","volume":"220","author":"Odia","year":"2020","journal-title":"Am J Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/274\/64287894\/usaf158.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/274\/64287894\/usaf158.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T06:19:54Z","timestamp":1758349194000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/Supplement_2\/274\/8256250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":12,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf158","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,9,1]]}}}