Clinical Predictors of Urgent Findings on Abdominopelvic CT in Emergency Department Patients with Crohn’s Disease

Abstract

Background & Aims In the United States, the use of abdominopelvic computed tomography (APCT) by emergency departments for patients with abdominal pain has increased, despite stable admission rates and diagnosis requiring urgent intervention. We proposed that trends would be similar for patients with Crohn's disease (CD). Methods We conducted a retrospective study of data from 648 adults with CD who presented at 2 emergency departments (2001–2009; 1572 visits). Trends in APCT use were assessed with Spearman's correlation coefficient. We compared patient characteristics and APCT findings during 2001–2003 and 2007–2009. Results APCT use increased from 2001 (used for 47% of encounters) to 2009 (used for 78% of encounters; P=.005), whereas admission rates were relatively stable, at 68% in 2001 and 71% in 2009 (P=.06). The overall proportion of APCTs with findings of intestinal perforation, obstruction, or abscess was 29.0%; 34.9% of APCTs were associated with urgent diagnoses, including those unrelated to CD. Between 2001–2003 and 2007–2009, the proportions of APCTs that detected intestinal perforation, obstruction, or abscess were similar (30% vs 29%, P=.92), as were the proportions used detecting any diagnosis requiring urgent intervention, including those unrelated to CD (36% vs 34%, P=.91). Conclusions Despite the increased use of APCT by emergency departments for patients with CD, there were no significant change in admission rates between the periods of 2001–2003 and 2007–2009. The proportion of APCTs that detected intestinal perforation, obstruction, abscess, or other urgent conditions not related to CD remained high.

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

“…Stricturing or penetrating disease, heart rate [100 beats/min, leukocyte count [10,000/mm 3 , and CRP [2.5 mg/dL were independent predictors of urgent findings on APCT, whereas biologic agent use was a negative predictor of urgent findings. To date, there has been only one study that investigated clinical predictors of urgent findings on APCT in ED patients with CD [13]. In comparison with the previous study, the strength of our study is that we assessed in detail the clinical impact of APCT on non-urgent findings.…”

“…However, Kerner et al [12] revealed that, despite the increased use of APCT by EDs for patients with CD, there were no significant changes in admission rate or the proportion of APCT with urgent findings. Their studies also reported that, among patients with CD who presented to the ER, only one-third of APCTs were associated with CD-related or non-CD-related urgent findings [12,13]. In other words, two-thirds of patients without urgent findings could potentially have avoided radiation exposure.…”

CT enterography for Crohn’s disease: optimal technique and imaging issues

“…This should be based on history and physical findings. In one analysis, a prior history of intestinal obstruction or intraabdominal abscess, current hematochezia, and leukocytosis (WBC count >12,000 lL) were independent predictors of urgent findings on a subsequent CT (abscess, perforation, obstruction, or new or worsening non-Crohn's disease findings) [74]. If the patient presentation warrants immediate imaging, then a CT should be performed.…”

“…First, MRE is generally not a practical imaging alternative for emergency department patients. Recent investigations have shown that CT imaging in the emergency setting is very efficacious in identifying important complications of Crohn's disease [71,72,74]. However, before contemplating a CT, risk stratification should be performed by the ordering physician.…”

“…Studies have shown that CTE substantially changes clinical management and improves physician confidence level in a large number of patients with Crohn's disease [69][70][71][72][73][74]. The postoperative patient (within 2-3 weeks), most often presents with signs of infection.…”