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

Govani SM1,2,3, Higgins PDR1, Rubenstein JH1,2, Stidham RW1, Waljee AK1,4. PLoS One. 2018 Mar 29;13(3):e0195022. doi: 10.1371/journal.pone.0195022. eCollection 2018.

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1 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.


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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