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Clinical Predictors of Urgent Findings on Abdominopelvic CT in Emergency Department Patients with Crohn’s Disease

Kerner, Caroline MD, MSCE*,†; Carey, Kathleen BA*; Baillie, Charles MD; Mills, Angela M. MD; Yang, Wei PhD; Hilton, Susan MD§; Synnestvedt, Marie B. PhD; Weiner, Mark G. MD; Lewis, James D. MD, MSCE*,†

doi: 10.1097/MIB.0b013e31828133ad
Original Clinical Article

Background: Patients with Crohn’s disease (CD) are frequently exposed to diagnostic radiation in emergency departments (EDs). We aimed to examine clinical predictors of urgent abdominopelvic computed tomography (APCT) findings in this population.

Methods: A retrospective cross-sectional study was performed among adults with CD presenting to 2 emergency departments with a gastrointestinal chief complaint. The outcome, APON (abscess, perforation, obstruction, new or worsening non–CD-related findings), included APCTs with new or worsening CD-related or non-CD-related urgent findings. Variables with P < 0.05 in bivariate analyses were included in a multivariable logistic regression model, which was also used to develop a risk score for APON.

Results: A total of 481 APCTs were performed and 166 (34.5%) identified APON. Variables retained in the final model were history of intestinal obstruction (odds ratio [OR]: 3.78, 95% confidence interval [CI]: 2.27–6.28), history of intraabdominal abscess (OR: 2.64, 95% CI: 1.43 to 4.88), current hematochezia (OR: 0.38, 95% CI: 0.21 to 0.68), and white blood cell count >12,000/μL (OR: 2.49, 95% CI: 1.63 to 3.84). The c-statistic was 0.72. The risk score subtracts 1 point for hematochezia, and adds 1 point for each of the other variables. Among patients with a risk score of −1, the predicted and observed risk for APON was 9% and 6%, respectively. Any score greater than −1 had a predicted and observed risk of 19.8% and higher.

Conclusions: An APON risk score of −1 is associated with a low risk of urgent APCT findings in patients with CD in the emergency department. Implementation of such a tool may support clinical decision-making in the ED setting.

Article first published online 2 April 2013

*Division of Gastroenterology;

Center for Clinical Epidemiology and Biostatistics;

Department of Emergency Medicine;

§Department of Radiology;

Office of Human Research;

Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Reprints: Caroline Kerner, MD, MSCE, Division of Gastroenterology, University of Pennsylvania, Penn Tower, 9th Floor, 1 Convention Avenue, Philadelphia, PA 19104 (e-mail: caroline.kerner@uphs.upenn.edu).

Supported by National Institutes of Health T32-DK007740 and K24-DK078228.

The authors have no conflicts of interest to disclose.

Received August 22, 2012

Accepted September 04, 2012

© Crohn's & Colitis Foundation of America, Inc.
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