Risk stratification of emergency department patients with Crohn's disease could reduce computed tomography use by nearly half.
Risk stratification of emergency department patients with Crohn's disease could reduce computed tomography use by nearly half.
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DOI：
10.1016/j.cgh.2014.02.036
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发表时间：
2014-10
影响因子：
12.6
通讯作者：
Higgins, Peter D. R.
中科院分区：
文献类型：
--
作者：
Govani, Shail M.;Guentner, Amanda S.;Waljee, Akbar K.;Higgins, Peter D. R.
Computed Tomography (CT) is a useful tool in Crohn’s disease (CD) to assess disease activity and exclude complications. Excessive radiation has been associated with increased risk of malignancy. We aimed to identify automatable algorithms with a high negative predictive value (NPV) of a significant CT finding in patients with CD presenting to the emergency department. We conducted a retrospective review of a tertiary center’s medical records to identify adults with a diagnosis of CD who presented from 2000–2011. Logistic regression was used to model (1) complications [perforation, abscess or other serious finding] and (2) inflammation. There were 1095 visits for 613 individuals with a CT scan within 24 hours of arrival. The average number of CTs was 1.8 with a range of 1–31. Complications occurred in 16.8% of CTs. Inflammation was found in 54.5% of CTs while any new/worse finding was found in 67.2%. Using 10-fold cross validation to evaluate our models, the area under the receiver operating characteristic curve for the complications model is 0.80 (95%CI: 0.74–0.86) and the inflammation model is 0.71 (95%CI: 0.68–0.74). Scanning only patients with model-predicted complications would reduce scans by 43.0%, with a miss rate of 0.8% (4/491). Patients presenting to the emergency department with CD undergo CT scanning frequently but have no significant findings in 32.8% and complications in only 17%. Models with high NPVs were identified and could aid physicians in the decision to avoid CT scans in patients with low likelihood of a positive scan. Studies are needed to validate these models beyond a single center.
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影响因子：
12.6
作者：
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