Diagnostic hypotheses and acute tomographic findings in the emergency room of a tertiary hospital: an accuracy study

INTRODUCTION: Growing technological innovation represents an advance in medical decision-making. However, the large number of computed tomography (CT) scans performed in the emergency department is worrying due to the costs generated by the hospital and the exposure of patients to ionizing radiation. The availability and performance of the exam, however, does not necessarily mean an increase in diagnoses, and some of these exams may not show any pathology or alteration. Thus, our study aims to evaluate the accuracy between the emergency physician's diagnostic hypothesis and the results of the requested tomography of the skull, thorax and abdomen segments. METHODOLOGY: Prospective cross-sectional study between September 2023 and February 2024. The sample consisted of 331 patients, the inclusion criteria being: majority, having undergone a tomographic examination of the skull, chest or abdomen and having signed the Free and Informed Consent Form (ICF).). Statistical analysis was performed using IBM SPSS Statistics 27.0 software. RESULTS: 409 CT scans were analyzed, of the CT scans performed, 49.74% were devoid of acute findings. Proportion of agreement with the initial clinical diagnostic hypothesis was 39.5% in the skull, 40.3% in the abdomen and 43.7% in the thorax. CONCLUSION: This study identified low agreement between clinical hypotheses formulated in the emergency room of a tertiary hospital and acute tomographic findings, highlighting situations in which the use of CT was considered unnecessary for formulating the final diagnosis. However, it is pertinent to highlight the limitations of the study, above all, the impossibility of directly evaluating the reasons why each exam was requested within the subjective nuances of clinical practice.