CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital

PLOS ONE, Nov 2019

Objectives Patients with inflammatory bowel disease(IBD) are frequently exposed to computed tomography (CT). Each CT exposes patients to radiation that cumulatively could increase the risk of malignancy, particularly in younger patients. We aim to study the effect of age on CT use in IBD patients seen in the Emergency Department (ED) or the hospital. Methods We conducted a retrospective cohort study of IBD patients identified in Truven Health Marketscan databases between 2009–2013. The main outcome was use of CT during an ED or inpatient visit. Effect of age on CT use was characterized using logistic regression accounting for important covariables. Results There were 66,731 patients with IBD with 144,147 ED or inpatient visits in this cohort with a diagnosis code of IBD. At first visit, 5.8% percent were below age 18. CT was utilized in 26.6% of visits. In multivariable analysis, adjusting for medications, recent surgery, and gender, patients 18–35 were more likely to undergo CT (OR 2.35, 95%CI: 2.20–2.52) compared to those <18. Examining patients only between 16 and 19, the odds of an 18 or 19-year-old undergoing CT is significantly higher than a 16 or 17-year-old (OR 1.96, 95%CI: 1.71–2.24). Conclusions Patients with IBD undergo CT more than a quarter of the time in the ED or inpatient setting. Pediatric providers limit radiation exposure among those <18 while adult providers are not as cautious with radiation exposure for the young adult population. Increased awareness of the risks of cumulative radiation exposure in the young adult population is needed.

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CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital

March CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital Shail M. Govani 0 1 Peter D. R. Higgins 0 1 Joel H. Rubenstein 0 1 Ryan W. Stidham 0 1 Akbar K. Waljee 0 1 0 Department of Internal Medicine, University of Michigan , Ann Arbor, MI , United States of America, 2 South Texas Veterans Healthcare System , San Antonio, Texas , United States of America , 3 UT Health San Antonio, San Antonio, Texas , United States of America, 4 VA Center for Clinical Management Research, VA Ann Arbor Health Care System , Ann Arbor, Michigan , United States of America 1 Editor: John Green, University Hospital Llandough , UNITED KINGDOM Patients with inflammatory bowel disease(IBD) are frequently exposed to computed tomography (CT). Each CT exposes patients to radiation that cumulatively could increase the risk of malignancy, particularly in younger patients. We aim to study the effect of age on CT use in IBD patients seen in the Emergency Department (ED) or the hospital. - Data Availability Statement: The data analyzed herein are part of a third party commercial data base, Truven Marketscan Commercial Claims and Encounters database. The authors do not have permission to make the dataset available to readers. Interested researchers can obtain the data in the same fashion in which the authors obtained them, by contacting Truven directly at . The authors had no special access privileges to these data. Objectives Results We conducted a retrospective cohort study of IBD patients identified in Truven Health Marketscan databases between 2009±2013. The main outcome was use of CT during an ED or inpatient visit. Effect of age on CT use was characterized using logistic regression accounting for important covariables. There were 66,731 patients with IBD with 144,147 ED or inpatient visits in this cohort with a diagnosis code of IBD. At first visit, 5.8% percent were below age 18. CT was utilized in 26.6% of visits. In multivariable analysis, adjusting for medications, recent surgery, and gender, patients 18±35 were more likely to undergo CT (OR 2.35, 95%CI: 2.20±2.52) compared to those <18. Examining patients only between 16 and 19, the odds of an 18 or 19-year-old undergoing CT is significantly higher than a 16 or 17-year-old (OR 1.96, 95%CI: 1.71±2.24). Conclusions Patients with IBD undergo CT more than a quarter of the time in the ED or inpatient setting. Pediatric providers limit radiation exposure among those <18 while adult providers are not as cautious with radiation exposure for the young adult population. Increased awareness of the risks of cumulative radiation exposure in the young adult population is needed. Funding: Dr Waljee's research is funded by a VA HSR&D CDA-2 Career Development Award 1IK2HX000775. The sponsor had no role in the study design, data collection and analysis, decision to publish or preparation of this manuscript. Background Inflammatory bowel disease (IBD) is a chronic relapsing and remitting autoimmune disorder of the gastrointestinal tract. IBD often presents at a young age, with a majority of patients diagnosed before age 30[ 1,2 ]. It is associated with significant morbidity with complications that include toxic megacolon, abscesses, fistulas, and obstructions. Computed tomography (CT) is an important tool in the diagnosis of such complications[ 3,4 ] and is increasingly used as this technology becomes more readily available[ 5 ]. However, the benefits of CT use must be balanced with the radiation exposure, which is particularly problematic as patients with IBD are frequently exposed to repeated CT. Based on data from atomic bomb survivors and nuclear industry workers, radiation exposures over 50mSv are associated with an increased risk of malignancy[ 6 ]. This risk is particularly great for patients who are exposed to radiation at young ages. Radiation exposures from CT of the abdomen and pelvis are estimated to be between 4-45mSv (median 16mSv)[ 7 ]. Patients with IBD are at risk for repeated radiation exposures from CT so as a result, cohort studies have found that up to 25% of patients with IBD have been exposed to more than 50mSv [ 8 ]. Radiation exposure in the hospital setting makes up a significant amount of this exposure. Seventy-five percent of radiation exposure in this patient population has been attributed to CT scans with 34% of CT scans performed in the emergency department (ED) and 31% of Crohn's disease patients who are admitted undergoing CT[ 9 ]. These cumulative exposures are receiving increased attention as an important source of unnecessary radiation exposure[ 10 ]. Campaigns like ªImage Gentlyº have improved recognition of this issue in the pediatric population through increasing education for providers and patient's families[ 11,12 ]. While the importance of limiting radiation exposure is important among the pediatric population, the increased risk of malignancy due to prior radiation exposur (...truncated)


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Shail M. Govani, Peter D. R. Higgins, Joel H. Rubenstein, Ryan W. Stidham, Akbar K. Waljee. CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital, PLOS ONE, 2018, Volume 13, Issue 3, DOI: 10.1371/journal.pone.0195022