Clinical predictors of urgent findings on abdominopelvic CT in emergency department patients with Crohn's disease.
Clinical predictors of urgent findings on abdominopelvic CT in emergency department patients with Crohn's disease.
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DOI：
10.1097/mib.0b013e31828133ad
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发表时间：
2013-05
影响因子：
4.9
通讯作者：
Lewis JD
中科院分区：
文献类型：
--
作者：
Kerner C;Carey K;Baillie C;Mills AM;Yang W;Hilton S;Synnestvedt MB;Weiner MG;Lewis JD
在美国，急诊科对腹痛患者使用腹盆计算机断层扫描（APCT）的情况有所增加，尽管入院率稳定，诊断需要紧急干预。我们提出克罗恩病（CD）患者的趋势相似。我们对648例在2个急诊科就诊的成人CD患者的数据进行了回顾性研究（2001-2009年; 1572次就诊）。使用斯皮尔曼相关系数评估APCT使用趋势。我们比较了2001-2003年和2007-2009年的患者特征和APCT结果。APCT的使用从2001年（用于47%的遭遇）增加到2009年（用于78%的遭遇; P= 0.005），而入院率相对稳定，2001年为68%，2009年为71%（P= 0.06）。发现肠穿孔、梗阻或脓肿的APCT的总体比例为29.0%; 34.9%的APCT与紧急诊断相关，包括与CD无关的诊断。在2001-2003年和2007-2009年之间，检测到肠穿孔、梗阻或脓肿的APCT比例相似（30% vs 29%，P= 0.92），用于检测任何需要紧急干预的诊断的比例也相似，包括与CD无关的诊断（36% vs 34%，P= 0.91）。尽管急诊科对CD患者的APCT使用增加，但2001-2003年和2007-2009年期间的入院率没有显著变化。检测到肠穿孔、梗阻、脓肿或其他与CD无关的紧急情况的APCT比例仍然很高。
In the United States, the use of abdominopelvic computed tomography (APCT) by emergency departments for patients with abdominal pain has increased, despite stable admission rates and diagnosis requiring urgent intervention. We proposed that trends would be similar for patients with Crohn's disease (CD). We conducted a retrospective study of data from 648 adults with CD who presented at 2 emergency departments (2001–2009; 1572 visits). Trends in APCT use were assessed with Spearman's correlation coefficient. We compared patient characteristics and APCT findings during 2001–2003 and 2007–2009. APCT use increased from 2001 (used for 47% of encounters) to 2009 (used for 78% of encounters; P=.005), whereas admission rates were relatively stable, at 68% in 2001 and 71% in 2009 (P=.06). The overall proportion of APCTs with findings of intestinal perforation, obstruction, or abscess was 29.0%; 34.9% of APCTs were associated with urgent diagnoses, including those unrelated to CD. Between 2001–2003 and 2007–2009, the proportions of APCTs that detected intestinal perforation, obstruction, or abscess were similar (30% vs 29%, P=.92), as were the proportions used detecting any diagnosis requiring urgent intervention, including those unrelated to CD (36% vs 34%, P=.91). Despite the increased use of APCT by emergency departments for patients with CD, there were no significant change in admission rates between the periods of 2001–2003 and 2007–2009. The proportion of APCTs that detected intestinal perforation, obstruction, abscess, or other urgent conditions not related to CD remained high.