Predictors of Excessive CT Scan Use in a Surgical Cohort of Patients With Crohn's Disease

Abstract

Background: Patients with Crohn's disease typically undergo computed tomography (CT) scans periodically over the course of their chronic disorder, requiring only modest doses of ionizing radiation. However, previous studies have suggested there is a subgroup of patients with Crohn's disease who undergo frequent CT scans with an associated increase in health care expenditures and possible overexposure to radiation, potentially placing such patients at increased risk for cancer. The aim of our study was to characterize and define this potentially vulnerable cohort using a relatively homogeneous surgical population. Methods: Consecutive patients who underwent ileocolic resection for Crohn's disease from January 2000 to September 2010 at an academic medical center were identified from a prospectively maintained database. Only patient CT scans remote from surgery or hospitalization were considered in the analysis. The number of outpatient CT scans, physician visits, and coexisting psychiatric and functional diagnoses were recorded from retrospective chart review. Patients who were considered high CT scan utilizers were compared with patients who were low utilizers. Results: Sixty-three patients underwent 126 CT scans during the study period, however, 4 of the patients accounted for 52 (41%) of the studies. Compared with the overall study population, the subset of 4 patients (high utilizers) had a median of 66 clinic visits (P < 0.001) and 40 emergency department visits (P < 0.001). All 4 patients were on chronic narcotic medication, and only 1 did not have a concomitant functional disorder. Missed appointments and the absence of prescribed antidepressants were common among patients with high CT use. Conclusions: Although use of CT appears moderate in surgical patients with Crohn's disease overall, there is a subset of patients with chronic pain and psychiatric diagnoses, who frequently miss appointments, and account for a markedly disproportionate number of scans performed. Interestingly, use of antidepressants in patients with Crohn's disease was strongly associated with fewer scans, suggesting an opportunity for therapeutic intervention.