Kerri Glassner, DO1, Lindsay Euers, MD1, Prianka Gajula, MD1, Michelle Jones-Pauley, DO1, Chika F. Ezeana, MD, MS1, Mamta Puppala, MS1, Lin Wang, PhD1, Stephen T. Wong, PhD1, Ayah Oglat, MD2, Stephanie Nickerson, FNP1, Bincy Abraham, MD, FACG1
1Houston Methodist Hospital, Houston, TX; 2Baylor College of Medicine, Houston, TX
Introduction: Patients with inflammatory bowel disease (IBD) frequently have CT scans performed during emergency department (ER) visits and hospitalizations. Previous studies found that the younger a patient is when a CT scan is performed, the higher the risk of malignancy over a lifetime. Younger IBD patients have also been shown to have an increased frequency of ER visits, thus placing them at risk for repeat CT scans. Our aim was to determine the risk factors for and frequency of CT scans performed in all IBD patients seen in our ER.
Methods: A retrospective analysis of IBD patients seen at Houston Methodist Hospital ER from 2014 to 2017 was performed using ICD codes to identify patients with Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis from the EMR. There were 559 unique patients with 1489 unique visits confirmed after individual chart review. Data was collected on demographics including age, sex, and ethnicity; medications; and imaging (CT of the abdomen/pelvis).
Results: Of the 559 patients with ER visits, 61% were female with an average age of 50, (range 18-95). There were 65% with CD, 34% with UC, and less than 1% had indeterminate IBD. Of these, 23% were on a biologic, 15% on an immunomodulator, and 27% were treated with steroids for IBD. There were 325 patients (58%) with 599 visits during which a CT scan was performed, and of these 88% were ordered in the ER. The average age was 46, and 60% were female. IBD was the primary reason for the visit in 66%. There were 68% with CD, 31% with UC, 24% on a biologic medication, 17% immune modulator, and 35% received steroids. Older age was associated with a decreased risk of CT scan p=< 2.2x10-16, R -0.002, as well as UC compared to CD, p=0.009, R -0.06. There was an increased risk of CT scan in patients on a biologic, p=0.038, R 0.04, immunomodulator, p=0.039, R 0.029, or when steroids were given for IBD, p=1.44x10-13, R0.102. There was an increased risk of undergoing a CT scan when the primary reason for the visit was for IBD, p=< 2.2x10-16, R0.372.
Discussion: Over half of the IBD patients in our study population had CT scans performed, which almost always occurred in the ER. There was an increased risk of a CT in those on a biologic, immunomodulator, or steroids for IBD, suggesting that more severe disease may contribute. Younger patients and those with CD also had an increased risk. Guidelines are needed to limit repeat CT scans in young IBD patients to reduce the risk of increased malignancy over their lifetime.
Citation: Kerri Glassner, DO; Lindsay Euers, MD; Prianka Gajula, MD; Michelle Jones-Pauley, DO; Chika F. Ezeana, MD, MS; Mamta Puppala, MS; Lin Wang, PhD; Stephen T. Wong, PhD; Ayah Oglat, MD; Stephanie Nickerson, FNP; Bincy Abraham, MD, FACG. P0499 - RISK FACTORS FOR AND FREQUENCY OF CT SCANS IN INFLAMMATORY BOWEL DISEASE PATIENTS SEEN IN THE EMERGENCY DEPARTMENT. Program No. P0499. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.