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

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.

研究目的：
炎症性肠病（inflammatory bowel disease, IBD）患者常需接受计算机断层扫描（computed tomography, CT）检查。每次CT扫描都会使患者暴露于电离辐射中，累积辐射剂量可能增加恶性肿瘤发生风险，对于年轻患者而言这一风险尤为突出。本研究旨在探究年龄对急诊科（Emergency Department, ED）或住院病房就诊的IBD患者接受CT检查情况的影响。

研究方法：
本研究针对2009年至2013年间在Truven Health Marketscan数据库中识别出的IBD患者开展了一项回顾性队列研究。本研究的主要结局指标为患者在急诊科或住院就诊期间接受CT检查的情况。采用校正了重要协变量的logistic回归模型，分析年龄对CT检查使用率的影响。

研究结果：
本队列共纳入66731名IBD患者，累计发生144147次带有IBD诊断编码的急诊科或住院就诊。首次就诊时，5.8%的患者年龄低于18岁。26.6%的就诊患者接受了CT检查。多变量分析结果显示，在校正了用药情况、近期手术史以及性别等混杂因素后，18~35岁患者相较于<18岁患者更易接受CT检查（比值比odds ratio, OR=2.35，95%置信区间confidence interval, CI：2.20~2.52）。进一步聚焦16~19岁人群的亚组分析显示，18或19岁患者接受CT检查的比值显著高于16或17岁患者（OR=1.96，95%CI：1.71~2.24）。

研究结论：
IBD患者在急诊科或住院就诊期间，有超过四分之一的概率接受CT检查。儿科医疗团队会对18岁以下患者的辐射暴露加以限制，而成人医疗团队对于年轻成年群体的辐射暴露则未采取同等谨慎的管控措施。未来需进一步提升对年轻成年群体累积辐射暴露风险的认知水平。