Evaluation of Plain Abdominal Radiographs in the Diagnosis of Abdominal Pain

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Abstract
To develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, the relation between clinical data and radiographic abnormalities was prospectively studied. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5%) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral critera would result in minimal loss of clinically useful information, large financial savings and a reduction in radiation exposure.

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