The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department

Introduction Facial Computed Tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patient’s presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluates the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assess secondary consequences of routine facial CT use in this population by using turnaround time (TAT), cost and radiation exposure as the key parameters.

Material and Methods We retrospectively reviewed records of suspected DA patients over a five-year period, from June 2008 to June 2013. TAT for patients were calculated from the time the examination was ordered by ED physician, to the time that the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying DLP by the standard conversion coefficient (K) (k = 0.0021 mSv/mGy × cm). Cost CT was included for reference, but was not analyzed extensively due to the lack of standardization of costs across the various institutions.

Results Our investigation consisted of 117 patients, 75 males of average age 41(±12), and 42 females with average age 44(±17). Out of the total 117 patients that underwent a CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87(±71) minutes. Average effective radiation dose for a facial CT was 2.4(±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209.

Conclusion Our study shows that the routine use of Facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in a management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.