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The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease
Author(s) -
Israeli E.,
Ying S.,
Henderson B.,
Mottola J.,
Strome T.,
Bernstein C. N.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12410
Subject(s) - medicine , inflammatory bowel disease , emergency department , ulcerative colitis , referral , disease , population , gastroenterology , radiology , environmental health , family medicine , psychiatry
Summary Background Although exposure to diagnostic radiation may be associated with increased risk of malignancy, the use of abdominal CT ( ACT ) in the last decade has increased for patients in the emergency department ( ED ). Aim To examine the impact of ACT ordered in the ED on management of patients with inflammatory bowel diseases ( IBD ), as well as to quantify the cumulative effective dose ( CED ) of radiation received by these patients. Methods A total of 152 patients with Crohn's disease ( CD ) and 130 patients with ulcerative colitis ( UC ) that presented to the ED in a tertiary centre between 2009 and 2011 were identified. For patients that had an ACT , chart review assessed if the ACT findings changed clinical management. CED of diagnostic radiation ( DR ) was calculated for all imaging studies between 1 January 2006 and 30 August 2012. Results Abdominal CT use was 49% for CD and 19% for UC . ACT s with findings of penetrating/obstructive disease were 35% for CD . Urgent non‐ IBD ‐related diagnoses were found in 13% for CD and 28% for UC ( P < 0.05). ACT caused a change in management in 81% of CD and 69% of UC patients. Mean CED from DR was 77.4 ± 63.0 mSv (median 53 mSv) for CD and 67.2 ± 51.0 mSv (median 56 mSv) for UC ( P = 0.47). The CED for the 80‐month period exceeded 75 mSv in 35% and 36% respectively ( P = 0.99). Conclusions Although abdominal CT often changes management of IBD patients in the emergency department, this population carries a very high‐risk of radiation exposure. Efforts should be made to decrease this risk by development of low‐radiation protocols, and wider use of MRI /ultrasound.