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.
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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)