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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-04

AUTHORS

Yoon Suk Jung, Dong Il Park, Sung Noh Hong, Eun Ran Kim, Young Ho Kim, Jae Hee Cheon, Chang Soo Eun, Dong Soo Han, Chang Kyun Lee, Jae Hak Kim, Kyu Chan Huh, Soon Man Yoon, Hyun Joo Song, Jeong Eun Shin, Seong Ran Jeon

ABSTRACT

BACKGROUND: Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. AIM: To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). METHODS: A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P < 0.1 in univariate analyses were included in a multivariable logistic regression model. RESULTS: Of the 266 APCTs performed, 103 (38.7 %) had OPAN and 113 (42.5 %) required changes in treatment plan. Stricturing or penetrating disease (odds ratio [OR] 2.72, 95 % confidence interval [CI] 1.21-6.13), heart rate >100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. CONCLUSIONS: Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved. More... »

PAGES

929-935

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10620-014-3298-9

DOI

http://dx.doi.org/10.1007/s10620-014-3298-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1034678848

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25064212


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