A short communication (C Pant et al. JPGN 2015; 61: 282-84, ed 267-8) provides some insight into what is happening in the ER when patient with inflammatory bowel disease are evaluated.
The authors analyzed a national database, the Healthcare Cost and Utilizationa Porject Nationwide Emergency Department Sample (NEDS), from 2006-2010.
- ED visits for children 5-19 years of age increased from 14,527 (2006) –>18,193 (2010)
- Frequency of computerized tomography (CT) imaging increased 80.43% (P<0.01) for Crohn’s disease and 59.26% (P<0.01) for ulcerative colitis
- Overall rate of hospital admissions decreased by 14.32% (P<0.01)
The associated editorial by Jennifer Dotson and Michael Kappelman explain the limitations of relying on data that are derived mainly for billing rather than research and comment on the “alarming increase” in CT usage due to the risk of radiation exposure and the potential alternatives (eg. ultrasound, MRE). With regard to limitations, they likely included inaccurate and incomplete entries. In addition, the database included 950 hospitals, but may have under-sampled large freestanding children’s hospitals. This could skew the data. Finally, the data uses “visit-level” data rather than “patient-level” data; thus, one ‘cannot distinguish between a single patient who is seen on three separate visits or three unique patients.’
My take: There has been increasing use of ER visits and CT scanning for pediatric patients with IBD. One of my colleagues in town (Cary Sauer) has a humorous slide of a CT scanner as the entrance door to the ER. The message from this study indicates that we should be working on changing practice by working with our ER colleagues along with radiologists to minimize CT scans in favor of more gently imaging.
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