Predictive factors for clinically actionable computed tomography findings in inflammatory bowel disease patients seen in the emergency department with acute gastrointestinal symptoms

Andres J. Yarur, Amar B. Mandalia, Ryan M. Dauer, Frank Czul, Amar R. Deshpande, David H. Kerman, Maria T. Abreu, Daniel A. Sussman

Research output: Contribution to journalArticle

13 Scopus 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 ≥. 5. mg/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.

Original languageEnglish (US)
Pages (from-to)504-512
Number of pages9
JournalJournal of Crohn's and Colitis
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2014

Keywords

  • Computer tomography
  • Crohn's disease
  • Emergency department
  • Inflammatory bowel disease
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

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