title: Predictive factors for clinically actionable computed tomography findings in inflammatory bowel disease patients seen in the emergency department with acute gastrointestinal symptoms.
abstract: BACKGROUND
  The wide use of abdomino-pelvic computed tomography (APCT) in emergency departments (ED) has raised the concern for radiation exposure, costs and potential reactions to contrast agents. The aim of this study was to determine the yield and predictive factors for clinically actionable findings (CAF) in APCTs performed in patients with inflammatory bowel disease (IBD) who visit the ED.
  
  
  METHODS
  We performed a cross-sectional study including patients with IBD who visited the ED. Variables considered were demographics, IBD phenotype, clinical symptoms, IBD medication use prior to ED visit, laboratory values, and imaging results. The primary outcome was a composite of CAF, defined as new, intra-abdominal abscess or tumor, bowel obstruction, fistulae, diverticulitis, choledocholithiasis, or appendicitis.
  
  
  RESULTS
  354 patients were included. One or more CAF were reported in 26.6% of the APCTs (32.1% in CD and 12.8% in UC [p<0.01]). Independent predictive variables of CAF in CD were: CRP level ≥5mg/dl (p=0.04), previous history of IBD surgery (p=0.037), Black race (p<0.01) and low body mass index (p<0.01). None of the study variables predicted CAF in UC.
  
  
  CONCLUSIONS
  The yield for CAF with APCT in the ED was high for CD patients but minimal for those with UC and was not improved by the use of contrast. Elevated CRP, low BMI, Black race and previous history of IBD surgery predicted CAF in CD but no variables were predictive of CAF in UC.
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States.
authors.forename: Andres J
authors.initials: AJ
authors.lastname: Yarur
authors.affiliation: University of Miami, Miller School of Medicine, United States.
authors.forename: Amar B
authors.initials: AB
authors.lastname: Mandalia
authors.affiliation: University of Miami, Miller School of Medicine, United States.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Dauer
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States.
authors.forename: Frank
authors.initials: F
authors.lastname: Czul
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States.
authors.forename: Amar R
authors.initials: AR
authors.lastname: Deshpande
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States.
authors.forename: David H
authors.initials: DH
authors.lastname: Kerman
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Abreu
authors.affiliation: Division of Gastroenterology, University of Miami, Miller School of Medicine, United States. Electronic address: dsussman@med.miami.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Sussman
mesh_terms: D000208:Acute Disease; D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications / Q000000981:diagnostic imaging; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Computer tomography; Crohn's disease; Emergency department; Inflammatory bowel disease; Ulcerative colitis