Simple scoring system may safely reduce abdominopelvic CT in Crohn’s patients

Reuters Health - 29/12/2021 - A simple scoring system can prevent unnecessary abdominal-pelvic computed tomography (APCT) in the emergency department (ED) for patients with Crohn's disease (CD), according to researchers in Israel.

Writing in the Journal of Clinical Gastroenterology, they note that use of APCT in the ED among CD patients has risen steadily.

The main purpose of an APCT in the ED is to spot something that needs immediate intervention, such as obstruction, perforation, abscess, or non-CD-related urgent problem. Yet, studies have shown that only 30% to 40% of patients have significant findings.

This led Kinneret S. Riskin Geuz with Ben-Gurion University of the Negev in Haifa and Dr. Doron Schwartz with Soroka Medical Center in Beer Sheva to evaluate clinical and laboratory variables that can predict substantial findings on ED APCT.

They analyzed ED visits for 183 CD patients (mean age, 36 years; 61% men) who underwent an emergent APCT for gastrointestinal complaints over a 10-year period.

They compared patients with positive and negative findings on APCT in an attempt to uncover independent effects of different variables, including patients' characteristics, CD history, ED complaints, and laboratory tests.

Eighty-one patients (44%) had significant findings on ED APCT; small-bowel obstruction was the most common finding, accounting for 33 cases (41%). However, only 18 of the 81 patients (22%) with significant findings underwent invasive intervention.

Based on results of a logistic regression model, the researchers built a simple new scoring system called the CATCH score that includes seven items, each given a value of either +/- 1 (according to the direction of effect) or 0 (if negative or unknown).

The seven items are: ED complaint of diarrhea, ED complaint of fever, smoker, ileocolon location at diagnosis, ED neutrophils > 75% on differential white blood cell (WBC) count, ED platelets in complete blood count (CBC) > 350 billion/L and ED C-reactive protein (CRP) > 50 mg/L.

A score of 1 or greater as the cutoff value for ED APCT had a sensitivity of 85%, a specificity of 57%, a positive predictive value (PPV) of 61%, and a negative predictive value (NPV) of 83% for significant findings on APCT.

Using this score could have prevented the need for APCT in 70 patients in the study, or 42%.

Of note, say the researchers, despite the young average age of patient in the study, the average number of APCTs was 4.1 and some patients had as many as 22 APCTs performed in the short time since they were diagnosed with CD.

"The suggested CATCH score provides ED clinicians with a simple and easy decision tool regarding emergent need for an APCT. It is based only on readily available data from patients' history, complaints, and routine ED laboratory results," the developers say.

"We believe that adoption of the new suggested CATCH score at the ED can reduce unnecessary emergent APCTs. This can provide time for further thorough evaluation of these patients, preferably with consultation of a gastrointestinal specialist, resulting in a better patient-tailored therapeutic plan. Using the score can support and reassure ED physicians in their decision to avoid emergent APCT in patients with CD, which is commonly the harder decision to make," they write.

They say further studies are needed to validate the CATCH score in different populations, as well as reevaluate its predictive capability, cutoff values and ability to further decrease ED APCTs.

SOURCE: https://bit.ly/3FCK3IC Journal of Clinical Gastroenterology, online December 15, 2021.

By Reuters Staff



Posted on 29 December 20218 April 2024