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Objective:
The abdominal series (AXR) remains a frequently ordered test in the emergency department (ED), despite existing literature questioning its utility. The aim of this study was to characterize the use of the AXR in the ED by quantifying how often it is ordered and the frequency of subsequent imaging. Additionally, a time estimate in ED associated with the AXR was quantified. We hypothesized that there would be a low clinical utility of the AXR and long associated time period spent in the ED.

Materials and Methods:
A retrospective audit of AXRs performed in the ED from January to December 2019 was conducted. The local PACS and EMR were used to collect the variables. Variables included but were not limited to demographic information, frequency and type of follow-up imaging, pathology identified on imaging, and time stamps of imaging ordering and patient discharge.

Results:
Of 702 AXRs, 438 (62.4%) were normal, and 263 (37.5%) were abnormal. A Chi squared test showed that the two variables (abdominal series result and follow up imaging completion) were significantly related, with <em>p</em> < 0.001. However, the effect size was small (Nagelkerke R square= 0.022). The average time spent in the ED for these patients was 7.27 hours, and the average time between the AXR being ordered and completed was 1.31 hours.

Conclusion:
The majority of AXRs were normal. Our results showed that AXR had a statistically significant, but low clinically significant predictive ability on subsequent imaging ordering. This supports our hypothesis that the AXR is of low clinical utility with respect to the rate of ordering follow up imaging. The AXR also translated to a quantifiable time interval during the patient’s stay in ED. Minimizing overuse of the AXR may result in a decrease in patient duration in the ED.