Faculty Collaboration Database

Predictive factors for clinically actionable computed tomography findings in inflammatory bowel disease patients seen in the emergency department with acute gastrointestinal symptoms. J Crohns Colitis 2014 Jun;8(6):504-12

Date

11/28/2013

Pubmed ID

24275204

DOI

10.1016/j.crohns.2013.11.003

Scopus ID

2-s2.0-84899906180 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: The wide use of abdomino-pelvic computed tomography (APCT) in emergency departments (ED) has raised the concern for radiation exposure, costs and potential reactions to contrast agents. The aim of this study was to determine the yield and predictive factors for clinically actionable findings (CAF) in APCTs performed in patients with inflammatory bowel disease (IBD) who visit the ED.

METHODS: We performed a cross-sectional study including patients with IBD who visited the ED. Variables considered were demographics, IBD phenotype, clinical symptoms, IBD medication use prior to ED visit, laboratory values, and imaging results. The primary outcome was a composite of CAF, defined as new, intra-abdominal abscess or tumor, bowel obstruction, fistulae, diverticulitis, choledocholithiasis, or appendicitis.

RESULTS: 354 patients were included. One or more CAF were reported in 26.6% of the APCTs (32.1% in CD and 12.8% in UC [p<0.01]). Independent predictive variables of CAF in CD were: CRP level ≥5mg/dl (p=0.04), previous history of IBD surgery (p=0.037), Black race (p<0.01) and low body mass index (p<0.01). None of the study variables predicted CAF in UC.

CONCLUSIONS: The yield for CAF with APCT in the ED was high for CD patients but minimal for those with UC and was not improved by the use of contrast. Elevated CRP, low BMI, Black race and previous history of IBD surgery predicted CAF in CD but no variables were predictive of CAF in UC.

Author List

Yarur AJ, Mandalia AB, Dauer RM, Czul F, Deshpande AR, Kerman DH, Abreu MT, Sussman DA

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Colitis, Ulcerative
Crohn Disease
Cross-Sectional Studies
Emergencies
Emergency Service, Hospital
Female
Gastrointestinal Diseases
Humans
Inflammatory Bowel Diseases
Male
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed