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Diagnostic utility of computed tomography in patients presenting to the emergency department with unintended weight loss

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Abstract

Purpose

Unintended weight loss (UWL) is a common presenting symptom in the emergency department (ED) with several etiologies. Our study looks to evaluate the diagnostic utility of computed tomography (CT) in the evaluation of UWL in the ED.

Methods

We identified all patients who underwent CT of the chest, abdomen, or pelvis in the ED at our institution for the diagnosis of UWL from 2004 to 2020 and retrospectively reviewed their clinical history and imaging. CT findings were organized into 4 types: (1) definite cause for UWL identified, (2) possible findings for UWL, (3) incidental findings unrelated to UWL, and (4) normal scan. Associations between clinical and laboratory findings with positive CT scans were also examined.

Results

One hundred seventy-three eligible patients were identified; 40 patients were excluded due to history of malignancy or inadequate follow-up. One hundred thirty-three patients were included in the final cohort. Overall, the most common causes of UWL were non-malignant gastrointestinal (GI) conditions (n = 41, 30%) and cancer (n = 30, 23%). True-positive CT findings were identified in 48.8% of patients (65/133). Elevated white blood cell counts (p = <0.0001) and physical exam abnormalities (p = 0.02) were both significantly associated with CT abnormalities.

Conclusion

The use of CT scanning in the evaluation of UWL in the ED yielded a diagnosis in approximately half of all cases, indicating good diagnostic value. The most common causes of UWL were non-malignant GI conditions and cancer in this cohort.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Sanjay Rao, Elias G. Kikano, Daniel A. Smith, Sree Harsha Tirumani & Nikhil H. Ramaiya

  2. Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH, 44118, USA

    Sanjay Rao

Authors
  1. Sanjay Rao
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  2. Elias G. Kikano
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  3. Daniel A. Smith
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  4. Sree Harsha Tirumani
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  5. Nikhil H. Ramaiya
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Contributions

SR takes responsibility for the content of the manuscript, including the data and analysis. SR, EGK, and NHR conceived the study. SR, EGK, DAS, SHT, and NHR contributed to the study design. SR and SHT contributed to the statistical analysis. SR wrote the first draft of the manuscript and prepared the tables. EGK prepared the figures. SR and EGK contributed to data acquisition. SR, EGK, DAS, SHT, and NHR contributed to interpretation of the results and provided critical input into manuscript drafting and revisions. All authors attest to meeting the ICMJE.org authorship criteria.

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Correspondence to Sanjay Rao.

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Ethics approval and consent to participate

This retrospective study was approved by the institutional review board with waiver of informed consent.

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Yes.

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The authors declare that they have no conflict of interest.

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Rao, S., Kikano, E.G., Smith, D.A. et al. Diagnostic utility of computed tomography in patients presenting to the emergency department with unintended weight loss. Emerg Radiol 28, 771–779 (2021). https://doi.org/10.1007/s10140-021-01920-7

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  • DOI: https://doi.org/10.1007/s10140-021-01920-7

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