title: Clinic-based Point of Care Transabdominal Ultrasound for Monitoring Crohn's Disease: Impact on Clinical Decision Making.
abstract: OBJECTIVE
  The use of cross-sectional imaging is important to characterise inflammatory bowel disease [IBD] activity, extent, and location and to exclude complications, regardless of symptoms. The aim of this study was to evaluate the impact of routine use of sonography in the management of inflammatory bowel disease.
  
  
  METHODS
  A total of 49 patients with Crohn's disease were prospectively evaluated. Clinical symptoms (Harvey-Bradshaw Index [HBI]), disease character, serological markers of inflammation [C-reactive protein], and endoscopic evaluation were collected and reviewed by two independent IBD-specialty physicians. Clinical decisions regarding management were recorded. A separate, blinded physician then performed bowel ultrasound [US] and graded disease activity:] as inactive, mild, or active. A second blinded physician read and graded a sub-set of the US images. Clinical decisions of both IBD-physicians after US were independently recorded. Changes in clinical management following US information and inter-rater agreement on US disease activity parameters were evaluated. The concordance between US, CRP and clinical symptoms [HBI] were analysed. Follow-up data after US evaluation were collected.
  
  
  RESULTS
  Clinical decisions were changed after ultrasound assessment in 30/49 [60%] and 28/48 [58%] of cases, for each physician respectively [p < 0.0001 for each]. Many [59%] of the patients seen in clinic were asymptomatic with an HBI of 3 or less [n = 29]; however, 52% [n = 15] of these had active disease found on US, resulting in alterations in clinical management. The agreement in overall score between the US reviewers was good, ĸ = 0.749 [0.5814, 0.9180], p < 0.001.
  
  
  CONCLUSIONS
  Clinic-based point of care US can play a significant role in guiding therapeutic management and is an important adjunct to routine clinical and laboratory assessment.
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada knovak@ucalgary.ca.
authors.forename: Kerri
authors.initials: K
authors.lastname: Novak
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Divine
authors.initials: D
authors.lastname: Tanyingoh
authors.affiliation: Städtisches Klinikum Lüneburg, Lüneburg, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Petersen
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kucharzik
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kannengiesser
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Crohn’s disease; monitoring; point of care; ultrasound