Revista do Colégio Brasileiro de Cirurgiões
https://app.periodikos.com.br/journal/rcbc/article/doi/10.1590/0100-6991e-20263891
Revista do Colégio Brasileiro de Cirurgiões
Original Article

Estudo de acurácia entre hipóteses diagnósticas e achados tomográficos agudos em emergência de hospital terciário

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

Meir Eduarda da Rocha dos Santos; Matheus Alberto Cella; Alissa Schimidt San Martin; Kaliandra Menezes Canton; Luciana Estacia Ambros; Jorge Roberto Marcante Carlotto

http://dx.doi.org/10.1590/0100-6991e-20263891 RCBC, vol.53, e20263891, 2026
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Resumo

Objetivo: A crescente inovação tecnológica representa um avanço para tomada de decisões médicas. Entretanto, o vultoso número de tomografias computadorizadas (TC) realizadas no setor de emergência é preocupante em virtude dos custos gerados ao hospital e da exposição dos pacientes à radiação ionizante. A disponibilidade e realização do exame, todavia, não significa necessariamente aumento de diagnósticos, podendo uma parcela desses exames não apresentar nenhuma patologia ou alteração. Assim, nosso estudo objetiva avaliar a acurácia entre hipótese diagnóstica do emergencista e resultado da tomografia solicitada dos segmentos crânio, tórax e abdome.

Metodologia: Estudo transversal prospectivo entre setembro de 2023 e fevereiro de 2024. A amostra foi 331 pacientes, sendo os critérios de inclusão: maioridade, ter realizado exame tomográfico de crânio, tórax ou abdome e ter assinado o Termo de Consentimento Livre e Esclarecido (TCLE). A análise estatística foi realizada através do software IBM SPSS Statistics 27.0.

Resultados: Foram analisadas 409 tomografias, das TCs realizadas 49,74% foram desprovidas de achados agudos. Proporção de concordância com hipótese diagnóstica clínica inicial foi 39,5% no crânio, 40,3% no abdome e 43,7% no tórax.

Conclusão: Este estudo identificou baixa concordância entre hipóteses clínicas formuladas no pronto atendimento de um hospital terciário e achados agudos tomográficos, evidenciando situações nas quais o uso da TC foi considerado dispensável à formulação do diagnóstico final. Entretanto, é pertinente ressaltar as limitações do estudo, sobretudo, a impossibilidade de avaliar diretamente as razões pelas quais cada exame foi solicitado dentro das nuances subjetivas da prática clínica.

Palavras-chave

Emergência; Hipótese Diagnóstica; Laudo de Imagem; Acurácia; Tomografia Computadorizada

Abstract

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.

Keywords

Emergency; Diagnostic Hypothesis; Image Report; Accuracy; Computed Tomography

References

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Submitted date:
02/01/2025

Accepted date:
10/23/2025

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