Report calls for better imaging for patients with suspected bowel obstructions

Thursday 9 January 2020

The RCR has welcomed calls for better diagnosis and management of patients with potentially deadly bowel obstructions, while cautioning that the UK’s shortage of scanners and radiologists is hampering improvements. 

A report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), released today, compiled evidence from UK-wide case reviews and clinician surveys to make a series of recommendations for improving the care of adults with acute bowel obstruction.

It stresses the need for dedicated management pathways and better access to vital CT scans and surgical treatments.

The report estimates pathway improvements could impact nearly 800,000 patients who present to Accident and Emergency (A&E) departments each year with abdominal symptoms that could be life-threatening bowel obstructions.

Hospital imaging is crucial in identifying the need for emergency surgery, however, delays and issues around imaging is a running theme of the report.

The collated case reviews and surveys analysed by NCEPOD revealed that:

  • More than a quarter of emergency patients (27 per cent of reviewed cases and 25 per cent of clinician survey cases) were not given a CT scan with an intravenous contrast agent, which is the recommended first-line test for suspected bowel obstructions1
  • Nearly one-in-ten patients (9 per cent) sent for a CT scan with contrast had their scans delayed because of problems accessing CT scanners
  • A fifth of hospitals (19 per cent) said they needed more CT scanners in A&E 
  • Delays in imaging (of all scan types) led to delayed diagnoses in 61 per cent of patients


Commenting on the NCEPOD report, RCR Vice President for Clinical Radiology Dr Caroline Rubin said:

“The RCR strongly welcomes NCEPOD’s review, which plainly demonstrates that there is much more to be done to improve the care of patients with emergency bowel obstructions, and that rapid access to imaging scanners and radiology expertise is crucial.

“The report authors recommend that all patients with suspected bowel obstruction are promptly sent for a CT scan with contrast, however, a significant number of patients are missing out on those scans, and restricted access to scanning equipment can delay diagnosis and treatment for those that do get them.

“To implement NCEPOD’s recommendations and ensure we can quickly detect life-threatening sepsis, intestinal tears and blood loss in these emergency patients, the NHS needs more diagnostic capacity. We need more scanners and more hospital-based radiologists to interpret complex abdominal scans2 but the UK is currently struggling with one of the lowest allocations of CT scanners in the developed world3 and a diagnostic radiologist workforce that is 30 per cent understaffed4.”  
 



References

  1. There is some clinical debate over the use of intravenous contrasts in patients with impaired renal function, however, the general opinion of NCEPOD’s advisory group is that it is a greater risk not to give these scans to emergency patients with suspected bowel obstruction.
  2. An RCR audit has found that in-house radiologists are more accurate at diagnosing emergency abdominal conditions than outsourced clinicians, see:  D.C. Howlett, K. Drinkwater, C. Frost et al, The accuracy of interpretation of emergency abdominal CT in adult patients who present with non-traumatic abdominal pain: results of a UK national audit, Clinical Radiology, 2017; 72.
  3. Based on the most recent UK data, the Organisation for Economic Co-operation and Development places the UK at 29 out of 33 countries for its number of CT scanners per population: https://stats.oecd.org/Index.aspx?DatasetCode=HEALTH_STAT
  4. Based on data from the latest RCR Clinical Radiology UK Workforce Census