CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital

Abstract

ObjectivesPatients with inflammatory bowel disease(IBD) are frequently exposed to computed tomography (CT). Each CT exposes patients to radiation that cumulatively could increase the risk of malignancy, particularly in younger patients. We aim to study the effect of age on CT use in IBD patients seen in the Emergency Department (ED) or the hospital.MethodsWe conducted a retrospective cohort study of IBD patients identified in Truven Health Marketscan databases between 2009–2013. The main outcome was use of CT during an ED or inpatient visit. Effect of age on CT use was characterized using logistic regression accounting for important covariables.ResultsThere were 66,731 patients with IBD with 144,147 ED or inpatient visits in this cohort with a diagnosis code of IBD. At first visit, 5.8% percent were below age 18. CT was utilized in 26.6% of visits. In multivariable analysis, adjusting for medications, recent surgery, and gender, patients 18–35 were more likely to undergo CT (OR 2.35, 95%CI: 2.20–2.52) compared to those <18. Examining patients only between 16 and 19, the odds of an 18 or 19-year-old undergoing CT is significantly higher than a 16 or 17-year-old (OR 1.96, 95%CI: 1.71–2.24).ConclusionsPatients with IBD undergo CT more than a quarter of the time in the ED or inpatient setting. Pediatric providers limit radiation exposure among those <18 while adult providers are not as cautious with radiation exposure for the young adult population. Increased awareness of the risks of cumulative radiation exposure in the young adult population is needed.

Risk Factors for and Frequency of CT Scans, Steroid Use, and Repeat Visits in Inflammatory Bowel Disease Patients Seen at a Single-Center Emergency Department: A Retrospective Cohort Study

“…Another retrospective study of almost 650 patients with CD in two emergency departments found similar results to ours [ 16 ]. Consistent with previous studies, we found higher rates of imaging use in patients with CD compared to UC [ 12 ] and in younger patients [ 29 ].…”

Imaging of Gastrointestinal Tract Ailments

“…There are also concerns about the significant ionizing radiation risk associated with multi-detector CT or repetitive CT imaging, especially in patients with IBD who may require frequent imaging throughout their lives, patients with IBD receive CT exams in the emergency department or inpatient setting more than a quarter of the time, and pediatric patients with IBD are particularly at risk of radiation exposure-related cancer mortality [ 70 , 71 ]. Therefore, pediatric providers often limit radiation exposure in patients under 18 years of age [ 72 ]. Nevertheless, due to the capability of detecting certain complications and explaining many morphologic changes of advanced UC, CT could be used as a complementary imaging method.…”