title: Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn's disease.
abstract: OBJECTIVE
  In the United States, the use of abdominopelvic computed tomography (APCT) by emergency departments for patients with abdominal pain has increased, despite stable admission rates and diagnosis requiring urgent intervention. We proposed that trends would be similar for patients with Crohn's disease (CD).
  
  
  METHODS
  We conducted a retrospective study of data from 648 adults with CD who presented at 2 emergency departments (2001-2009; 1572 visits). Trends in APCT use were assessed with Spearman correlation coefficient. We compared patient characteristics and APCT findings during 2001-2003 and 2007-2009.
  
  
  RESULTS
  APCT use increased from 2001 (used for 47% of encounters) to 2009 (used for 78% of encounters; P = .005), whereas admission rates were relatively stable at 68% in 2001 and 71% in 2009 (P = .06). The overall proportion of APCTs with findings of intestinal perforation, obstruction, or abscess was 29.0%; 34.9% of APCTs were associated with urgent diagnoses, including those unrelated to CD. Between 2001-2003 and 2007-2009, the proportions of APCTs that detected intestinal perforation, obstruction, or abscess were similar (30% vs 29%, P = .92), as were the proportions used to detect any diagnosis requiring urgent intervention, including those unrelated to CD (36% vs 34%, P = .91).
  
  
  CONCLUSIONS
  Despite the increased use of APCT by emergency departments for patients with CD, there were no significant changes in admission rates between the periods of 2001-2003 and 2007-2009. The proportion of APCTs that detected intestinal perforation, obstruction, abscess, or other urgent conditions not related to CD remained high.
authors.affiliation: Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kerner
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carey
authors.forename: Angela M
authors.initials: AM
authors.lastname: Mills
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Marie B
authors.initials: MB
authors.lastname: Synnestvedt
authors.forename: Susan
authors.initials: S
authors.lastname: Hilton
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003424:Crohn Disease / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult