Objectives To determine the value of abdominal radiography (AXR) for investigating patients attending hospital with a first episode of appendicitis (requiring appendicectomy), acute gallbladder disease or acute pancreatitis, and to identify if early (within 18 h) ultrasound or CT scanning reduces the use of AXR.

Setting Two acute teaching hospitals during August–September 2008 and February–March 2009.

Participants Audit of 355 patients (179 patients (50%) who underwent appendicectomy, 128 (36%) admitted with acute gallbladder disease and 48 (14%) with acute pancreatitis).

Results AXR was performed in 53 patients (30%) who underwent appendicectomy, 73 (57%) with acute gallstone disease and 38 (78%) with acute pancreatitis. The useful abnormality pick-up rate was low; 9% (n=5), 5% (n=4) and 0% (n=0), respectively. When used, ultrasound confirmed the diagnosis in 84% (140/166) and CT scanning (either after AXR or as first line) in 97% (34/35). 42 patients underwent early ultrasound (n=27) or CT scanning (n=15), which together reduced the rate of AXR usage by 34% (14/42 early vs 107/159 delayed, p<0.001).

Conclusions AXR does not aid diagnosis of these conditions but is still performed. Early ultrasound or CT scanning reduces the use of AXR and are more sensitive; methods of providing these should be explored.