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6 Ahmadi H. et al References. 1. Trott AT, Lucas RH. Acute abdominal pain. In: Rosen P, Barkin R, eds. Emergency medicine: concepts and clinical practice. 4 th ed. St. Louis: Mosby: 18; p Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg 176; 131: Birnbaum BA, Jeffrey RB Jr. and sonographic evaluation of acute right lower quadrant abdominal pain. AJR Am J Roentgenol 18; 170: Malone AJ. Unenhanced in the evaluation of the acute abdomen: the community hospital experience. Semin Ultrasound MR 1; 20: Gore RM, Miller FH, Pereles FS, Yaghmai V, Berlin JW. Helical in the evaluation of the acute abdomen. AJR Am J Roentgenol 2000; 174: Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal in the emergency department for patients with abdominal pain. Eur Radiol 2003; 13: MacKersie AB, Lane MJ, Gerhardt RT, Claypool HA, Keenan S, Katz DS, et al. Nontraumatic acute abdominal pain: (%5/5) (%15/4) %28 %45. unenhanced helical compared with three-view acute abdominal series. Radiology 2005; 237: Salem TA, Molloy RG, O'Dwyer PJ. Prospective study on the role of the scan in patients with an acute abdomen. Colorectal Dis 2005; 7: Anyanwu AC, Moalypour SM. Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. J R Coll Surg Edinb 18; 43: Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with evaluation. Radiology 2002; 225: Rao PM, Feltmate CM, Rhea JT, Schulick AH, Novelline RA. Helical computed tomography in differentiating appendicitis and acute gynecologic conditions. Obstet Gynecol 1; 3: de Bombal FT. Introduction In: de Bombal FT, editors. Diagnosis of acute abdominal pain. 2 nd ed. Edinburgh: Churchill livingstone: 11: p Eisenberg RL, Heineken P, Hedgcock MW, Federle M, Goldberg HI. Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain. Ann Surg 183; 17: Böhner H, Yang Q, Franke C, Verreet PR, Ohmann C. Simple data from history and physical examination help to exclude bowel

7 2 Accuracy of spiral in non-traumatic acute abdominal pain in obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg 18; 164: Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: evaluation of 54 cases. Radiology 1; 211: Rao PM, Rhea JT, Novelline RA. diagnosis of mesenteric adenitis. Radiology 17; 202: Lane MJ, Liu DM, Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical in 300 consecutive patients. Radiology 1; 213: Basak S, Nazarian LN, Wechsler RJ, Parker L, Williams BD, Lev-Toaff AS, et al. Is unenhanced sufficient for evaluation of acute abdominal pain? Clin Imaging 2002; 26: Megibow AJ, Balthazar EJ, Cho KC, Medwid SW, Birnbaum BA, Noz ME. Bowel obstruction: evaluation with. Radiology 11; 180: Obuz F, Terzi C, Sökmen S, Yilmaz E, Yildiz D, Füzün M. The efficacy of helical in the diagnosis of small bowel obstruction. Eur J Radiol 2003; 48: Neitlich JD, Topazian M, Smith RC, Gupta A, Burrell MI, Rosenfield AT. Detection of choledocholithiasis: comparison of unenhanced helical and endoscopic retrograde cholangiopancreatography. Radiology 17; 203: Peck J, Peck A, Peck C, Peck J. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. Am J Surg 2000; 180: Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol 2002; 178: Urban BA, Fishman EK. Tailored helical evaluation of acute abdomen. Radiographics 2000; 20: Cooperberg PL, Gibney RG. Imaging of the gallbladder, 187. Radiology 187; 163: Bau A, Atri M. Acute female pelvic pain: ultrasound evaluation. Semin Ultrasound MR 2000; 21: Kan JH, Fines BP, Funaki B. Conventional and hydrocolonic US of the appendix with correlation performed by on-call radiology residents. Acad Radiol 2001; 8: Downey D. The retroperitoneum and great vessels. In: Rumack CM, Wilson SR, Charboneau JW, Editors. Diagnostic ultrasound. St. Louis: Mosby Year Books: 18; p Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M. of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol 14; 162:

8 Evaluation of two surveillance methods for surgical site infection Tehran University Medical Journal; Vol. 65, No. 12, Mar 2008: Accuracy of spiral in non-traumatic acute abdominal pain in Sina university hospital Ahmadi H. 1 Tavakkoli H. 1 Bakhtavar KH. 2 Khodadadi F. 1* Abbasi A Department of Surgery 2- Department of Radiology 3- Department of Cardiology Clinical Research Unit, Medical Sciences, Tehran Heart Center Tehran University of Medical Sciences Abstract Background: Acute abdominal pain is a common complaint in an emergency setting. An immediate and precise diagnosis is necessary for reducing morbidity and mortality. Several studies have reported that scan increases diagnostic accuracy for patients with acute abdominal pain. This study was designed to evaluate the sensitivity, specificity and accuracy of spiral scan compared to that of abdominal ultrasound and plain radiography. Methods: We assessed the data of 1 consecutive patients, including 45 males and 46 females, ranging in age from 8 to 84 years (mean age years) presenting to the emergency department of Sina Hospital, Tehran, Iran, with acute non-traumatic abdominal pain during the years All patients underwent spiral scanning; in addition, sonography and plain radiography were performed for 66 and 64 of the patients, respectively. The sensitivity, specificity and accuracy were calculated and compared, based on the final diagnosis, which was established with surgical, pathologic, and clinical followup. The data was analyzed by SPSS 13.0 software. Results: Among the 1 patients examined, scan was reported to be normal in 15 patients (16.5%). The most common findings were aortic aneurysm (12.1%), pancreatitis (.%), ovarian cyst (7.7%), intestinal distension (7.7%), and hepatic cyst (7.7%). The overall sensitivity, specificity, and accuracy of unenhanced spiral were 2.2%, 2.86%, and 2.3%, respectively, whereas those of plain radiography were 13.2%, 72.7%, and 23.4%, respectively, and ultrasound 73.2%, 0%, and 75.7%, respectively. Conclusions: This study suggests that plain radiography is an insensitive technique in the evaluation of nontraumatic acute abdominal pain presenting in the emergency department. Unenhanced spiral is accurate for adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality. Keywords: Non-traumatic acute abdomen, spiral, accuracy *Corresponding author: Sina Hospital, Hasanabad Sq., Imam Khomeini Ave., Tehran. Tel: fkhodadadi@razi.tums.ac.ir