%0 Journal Article
%T A Model For Identifying Actionable Findings On Computed Tomography in Crohn¡¯s Disease Patients in the Emergency Department - A Model For Identifying Actionable Findings On Computed Tomography in Crohn¡¯s Disease Patients in the Emergency Department - Open Access Pub
%A Amy Laird PhD
%A Jack Wiedrick MS
%A Joshua Lum
%A Kian Keyashian MD
%A Kimberly Johnson
%A Michael Loudin
%J OAP | Home | Journal of Digestive Disorders And Diagnosis | Open Access Pub
%D 2017
%X Patients with inflammatory bowel disease (IBD) frequently visit the emergency department (ED). The use of cputed tomography (CT) scans in this population has drastically increased in recent years and may confer an increased risk of malignancy. Records were obtained for IBD patients aged 18 or older who visited our institutional ED with a gastrointestinal chief complaint and who had a CT scan ordered by an ED physician. A predictive model for identifying a clinically actionable finding (CAF) on CT scan was created using logistic regression carried out on a predetermined set of variables. Data were available on 156 Crohn¡¯s disease (CD) patients contributing 350 visits and 63 ulcerative colitis (UC) patients contributing 114 total visits. CAF was identified at 108/350 (30.9%) of visits in CD patients and 33/114 (29.0%) of visits in UC patients. History of CAF (OR 11.6, CI 4.54-29.6) and a platelet count above 400,000/mL (OR 3.42, CI 1.56-7.50) were the strongest predictors of CAF. History of psychiatric illness (OR 0.67, CI 0.35-1.29) and diarrhea (OR .043, CI 0.23-0.83) were associated with a lower likelihood of CAF. A prediction model was created that was able to detect 94.4% of CAF cases while correctly predicting CAF non-cases 35% of the time. This model holds promise as a tool to reduce imaging in this population. DOI10.14302/issn.2574-4526.jddd-17-1688 Inflammatory bowel disease (IBD) affects an estimated 1.5 million Americans.(1) Young age at onset and a relapsing-remitting disease course may lead to frequent and ongoing healthcare system interactions, a substantial proportion of which are in the emergency department (ED). IBD patients made an estimated 76,000 visits to the ED in 2005, an increase of 165% from the previous decade.(2) Abdominopelvic computed tomography (APCT) use in the ED increased in Crohn¡¯s disease (CD) patients from 47% in 2001 to 78% of all ED visits in 2009.(3) APCTs commonly reveal findings (abscess, perforation, obstruction, et cetera) in this population that change clinical management. Previous studies have shown that 16.8-48% of CD and 12.8% of ulcerative colitis (UC) patients receiving an APCT in the ED had a finding that changed clinical management.(3-9) However, APCTs are associated with a cost and may be associated with an increased risk for malignancy. It is estimated that one APCT confers an increased risk of malignancy of about 6/10,000, which when applied on a population level is estimated to account for 1.5-2% of all cancers in the United States.(10) Additionally, several studies have identified a subgroup of
%U https://www.openaccesspub.org/jddd/article/552