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Open Access 01-12-2021 | Crohn's Disease | Research

Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience

Authors: Mikael Verdalle-Cazes, Cloé Charpentier, Coralie Benard, Luc-Marie Joly, Jean-Nicolas Dacher, Guillaume Savoye, Céline Savoye-Collet

Published in: BMC Emergency Medicine | Issue 1/2021

Abstract

Background

Crohn’s disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department.

Methods

Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified.

Results

A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16–5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37–6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis.

Conclusion

In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery.

Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380(9853):1590–605. https://doi.org/10.1016/S0140-6736(12)60026-9.CrossRefPubMed

Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54 e42; quiz e30.CrossRefPubMed

Kerner C, Carey K, Mills AM, Yang W, Synnestvedt MB, Hilton S, et al. Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn’s disease. Clin Gastroenterol Hepatol. 2012;10(1):52–7. https://doi.org/10.1016/j.cgh.2011.09.005.CrossRefPubMed

Ananthakrishnan AN, McGinley EL, Saeian K, et al. Trends in ambulatory and emergency room visits for inflammatory bowel diseases in the United States: 1994-2005. Am J Gastroenterol. 2010;105(2):363–70. https://doi.org/10.1038/ajg.2009.580.CrossRefPubMed

Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1–8. https://doi.org/10.1016/j.annemergmed.2005.12.030.CrossRefPubMed

Vinton DT, Capp R, Rooks SP, Abbott JT, Ginde AA. Frequent users of US emergency departments: characteristics and opportunities for intervention. Emerg Med J. 2014;31(7):526–32. https://doi.org/10.1136/emermed-2013-202407.CrossRefPubMed

Govani SM, Guentner AS, Waljee AK, Higgins PDR. Risk stratification of emergency department patients with Crohn’s disease could reduce computed tomography use by nearly half. Clin Gastroenterol Hepatol. 2014;12(10):1702–7 e3. https://doi.org/10.1016/j.cgh.2014.02.036.CrossRefPubMedPubMedCentral

Israeli E, Ying S, Henderson B, Mottola J, Strome T, Bernstein CN. The impact of abdominal computed tomography in a tertiary referral Centre emergency department on the management of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(5):513–21. https://doi.org/10.1111/apt.12410.CrossRefPubMed

Yarur AJ, Mandalia AB, Dauer RM, Czul F, Deshpande AR, Kerman DH, et al. Predictive factors for clinically actionable computed tomography findings in inflammatory bowel disease patients seen in the emergency department with acute gastrointestinal symptoms. J Crohns Colitis. 2014;8(6):504–12. https://doi.org/10.1016/j.crohns.2013.11.003.CrossRefPubMed

10.

Gomollon F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and Management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2017;11(1):3–25. https://doi.org/10.1093/ecco-jcc/jjw168.CrossRefPubMed

11.

Henriksen M, Jahnsen J, Lygren I, Aadland E, Schulz T, Vatn MH, et al. Clinical course in Crohn’s disease: results of a five-year population-based follow-up study (the IBSEN study). Scand J Gastroenterol. 2007;42(5):602–10. https://doi.org/10.1080/00365520601076124.CrossRefPubMed

12.

Wolters FL, Russel MG, Sijbrandij J, Ambergen T, Odes S, Riis L, et al. Phenotype at diagnosis predicts recurrence rates in Crohn’s disease. Gut. 2006;55(8):1124–30. https://doi.org/10.1136/gut.2005.084061.CrossRefPubMedPubMedCentral

13.

Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, et al. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970-2004). Am J Gastroenterol. 2012;107(11):1693–701. https://doi.org/10.1038/ajg.2012.298.CrossRefPubMedPubMedCentral

14.

Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010;139(4):1147–55. https://doi.org/10.1053/j.gastro.2010.06.070.CrossRefPubMed

15.

Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–9. https://doi.org/10.1016/S0140-6736(02)08512-4.CrossRefPubMed

16.

Jung YS, Park DI, Hong SN, Kim ER, Kim YH, Cheon JH, et al. Predictors of urgent findings on abdominopelvic CT in patients with Crohn’s disease presenting to the emergency department. Dig Dis Sci. 2015;60(4):929–35. https://doi.org/10.1007/s10620-014-3298-9.CrossRefPubMed

17.

Kerner C, Carey K, Baillie C, Mills AM, Yang W, Hilton S, et al. Clinical predictors of urgent findings on abdominopelvic CT in emergency department patients with Crohn’s disease. Inflamm Bowel Dis. 2013;19(6):1179–85. https://doi.org/10.1097/MIB.0b013e31828133ad.CrossRefPubMed

18.

Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National trends in CT use in the emergency department: 1995-2007. Radiology. 2011;258(1):164–73. https://doi.org/10.1148/radiol.10100640.CrossRefPubMed

19.

Chatu S, Subramanian V, Pollok RC. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35(5):529–39. https://doi.org/10.1111/j.1365-2036.2011.04975.x.CrossRefPubMed

20.

Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505. https://doi.org/10.1016/S0140-6736(12)60815-0.CrossRefPubMedPubMedCentral

21.

Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57(11):1524–9. https://doi.org/10.1136/gut.2008.151415.CrossRefPubMed

22.

Palmer L, Herfarth H, Porter CQ, Fordham LA, Sandler RS, Kappelman MD. Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases. Am J Gastroenterol. 2009;104(11):2816–23. https://doi.org/10.1038/ajg.2009.480.CrossRefPubMedPubMedCentral

23.

Kroeker KI, Lam S, Birchall I, Fedorak RN. Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol. 2011;45(1):34–9. https://doi.org/10.1097/MCG.0b013e3181e5d1c5.CrossRefPubMed

24.

Casellas F, Fontanet G, Borruel N, Malagelada JR. The opinion of patients with inflammatory bowel disease on healthcare received. Rev Esp Enferm Dig. 2004;96(3):174–84. https://doi.org/10.4321/s1130-01082004000300003.CrossRefPubMed

25.

Ramos-Rivers C, Regueiro M, Vargas EJ, et al. Association between telephone activity and features of patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014;12(6):986–94 e1. https://doi.org/10.1016/j.cgh.2013.11.015.CrossRefPubMed

Title: Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience
Authors: Mikael Verdalle-Cazes
Cloé Charpentier
Coralie Benard
Luc-Marie Joly
Jean-Nicolas Dacher
Guillaume Savoye
Céline Savoye-Collet
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Crohn's Disease
Published in: BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-021-00512-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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