The linked multicentre study (doi:10.1136/bmj.b2431) of more than 1000 patients in the Netherlands reinforces previous research showing that imaging is worthwhile in acute abdominal pain severe enough to warrant hospital admission.1 2 In Laméris and colleagues’ study, imaging reduced clinical uncertainty and helped to eliminate a considerable number of false positive clinical diagnoses. The authors found that a strategy of using radiography followed by ultrasound worked well, with computed tomography being reserved for people with negative or inconclusive ultrasound results.1 This strategy provided the best sensitivity and the lowest radiation dose.

The success of this approach is not surprising because it effectively follows the recommendations of several national and international guidelines. Although most guidelines try to stratify imaging according to the location of the pain,3 4 these authors found that a “blanket” protocol was adequate. But patients with renal colic, for whom computed tomography has become the investigation of choice, …