Time to Change Upper GI Default Orders -No Routine Scout

When I place an order for an upper GI, the computer prompt asks whether this should be with or without a scout film.  A recent retrospective study (S Abdullah et al. JPGN 2018; 67: 576-9) provides data indicating that the default setting should be without a scout xray.

After reviewing UGIs in 197 outpatients over a 2 year period, the authors found that

  • 97% found no significant findings in scout xray
  • 1.5% (n=3) had findings that were not addressed
  • 1% (n=2) had findings that required additional evaluation –both minor lung findings, later deemed insignificant
  • 0.5% (n=1) had a finding which resulted in a change in management –>a cleanout for excessive stool.  The report does not state whether this patient had a rectal exam which generally is more accurate with regards to the need for a cleanout

My take: This study provides convincing data that scout studies are usually unnecessary.  For inpatients, the main reason to order a scout xray would be if a patient had previous contrast that needs to be cleared prior to UGI.

Related blog post: Pre-PEG UGIs Often Unnecessary

Lake Maligne, near Jasper Canada

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