Su1118 Increasing CT Scan Use and Higher Admission Rates for Crohn's Disease At a Tertiary Care Center Compared to National Rates

Guentner, Amanda; Govani, Shail M.; Waljee, Akbar K.; Higgins, Peter

doi:10.1016/s0016-5085(13)61485-7

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“…Patients with IBD frequently undergo cross sectional imaging as part of their inpatient and ED visits[ 5 , 15 , 17 – 19 ]. Prior studies of a tertiary care center in the United States [ 5 ] found that CT use increased in the ED setting from 25.8% to 40.2% of visits between 2000 and 2010 among patients with Crohn’s disease. In this administrative database, the rate of CT scan use among patients with a diagnosis of IBD was 26%.…”

Section: Discussionmentioning

confidence: 99%

“…It is associated with significant morbidity with complications that include toxic megacolon, abscesses, fistulas, and obstructions. Computed tomography (CT) is an important tool in the diagnosis of such complications[ 3 , 4 ] and is increasingly used as this technology becomes more readily available[ 5 ]. However, the benefits of CT use must be balanced with the radiation exposure, which is particularly problematic as patients with IBD are frequently exposed to repeated CT. Based on data from atomic bomb survivors and nuclear industry workers, radiation exposures over 50mSv are associated with an increased risk of malignancy[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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