title: Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn's Disease Presenting to the Emergency Department.
abstract: BACKGROUND
  Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population.
  
  
  OBJECTIVE
  To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED).
  
  
  METHODS
  A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P < 0.1 in univariate analyses were included in a multivariable logistic regression model.
  
  
  RESULTS
  Of the 266 APCTs performed, 103 (38.7 %) had OPAN and 113 (42.5 %) required changes in treatment plan. Stricturing or penetrating disease (odds ratio [OR] 2.72, 95 % confidence interval [CI] 1.21-6.13), heart rate >100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD.
  
  
  CONCLUSIONS
  Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.
authors: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea.
authors: Yoon Suk
authors: YS
authors: Jung
authors: Dong Il
authors: DI
authors: Park
authors: Sung Noh
authors: SN
authors: Hong
authors: Eun Ran
authors: ER
authors: Kim
authors: Young Ho
authors: YH
authors: Kim
authors: Jae Hee
authors: JH
authors: Cheon
authors: Chang Soo
authors: CS
authors: Eun
authors: Dong Soo
authors: DS
authors: Han
authors: Chang Kyun
authors: CK
authors: Lee
authors: Jae Hak
authors: JH
authors: Kim
authors: Kyu Chan
authors: KC
authors: Huh
authors: Soon Man
authors: SM
authors: Yoon
authors: Hyun Joo
authors: HJ
authors: Song
authors: Jeong Eun
authors: JE
authors: Shin
authors: Seong Ran
authors: SR
authors: Jeon
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D055815:Young Adult