Hansol Kang, MD1, Natalie Morris, MD2, Christine Chen, MD1, Hiba Hameed Chagla, MBBCh3, James Lewis, MD, MSCE4 1University of Pennsylvania Health System, Philadelphia, PA; 2University of Pennsylvania, Philadelphia, PA; 3Penn Medicine, Philadelphia, PA; 4University of Penn, Philadelphia, PA Introduction: Recent studies have identified a concerning trend of increasing abdominopelvic computed tomography (APCT) scan use in the management of Crohn’s disease (CD), particularly in emergency departments (ED). While risk calculators have been created to triage APCT usage in the ED, these tools have encountered barriers to widespread use. A recently published survey suggested that an acceptable risk calculator would need a sensitivity ≥ 95% and negative predictive value (NPV) ≥ 98%. In this study, we compared the ability of three published risk calculators to predict urgent findings in patients with CD in the ED. Methods: We conducted a cross-sectional study of patients with CD who underwent APCT in the ED. The cohort included patients with CD with an established gastroenterology provider who presented to the ED in a large health system with 6 hospitals. We defined urgent radiographic findings as perforations, obstructions, abscesses, or other non-CD acute findings (POANCD). Demographic and encounter characteristics for this cohort were summarized. Three risk calculators (Kerner 2013, Govani 2014, Riskin Guez 2022) were applied to the cohort to determine their test characteristics for identifying POANCD. Results: 300 encounters were reviewed, comprising 228 unique patients. Hospital admission occurred in 187 (62.3%) encounters. Surgery occurred in 16 (5.3%) encounters, with 15 (5.0%) being intra-abdominal. APCT identified 92 (30.7%) POANCD findings. Bowel obstruction was most common, followed by abscess, non-CD acute findings, and perforation. Kerner et al.’s calculator had a 98.9% sensitivity and 96.3% NPV. Govani et al.’s calculator had a 96.7% sensitivity and 89.7% NPV. Riskin Guez et al.’s calculator had a 71.7% sensitivity and 80.3% NPV. Discussion: The rate of POANCD findings in this study was similar to that reported by Kerner et al. (34.5%) but differed from that reported by Govani et al. (16.8%) and Riskin Guez et al. (44%), likely attributed to differences in population characteristics. When applying the risk calculators to this cohort, the calculators by Kerner et al. and Govani et al. achieved the desired ≥ 95% sensitivity. No calculators achieved the desired NPV ≥ 98%, noting that negative case numbers were too small to accurately capture the NPV. The study highlights the potential for application of Kerner et al.'s calculator to triage APCT usage while identifying opportunities for risk calculator optimization.
Figure: Table 1. Demographics, imaging findings, and management for Crohn’s patients who presented to the ED with abdominal complaints who were evaluated with APCT.
Figure: Table 2. Sensitivity, NPV, specificity and miss rates for POANCD findings using three published risk calculators to triage APCT usage in the ED for acute Crohn’s management.
Disclosures: Hansol Kang indicated no relevant financial relationships. Natalie Morris indicated no relevant financial relationships. Christine Chen indicated no relevant financial relationships. Hiba Hameed Chagla indicated no relevant financial relationships. James Lewis: 3M – Expert witness. AbbVie – Grant/Research Support. Amgen – Advisor or Review Panel Member. Dark Canyon Laboratories – Owner/Ownership Interest. Eli Lilly – Consultant, Grant/Research Support. Johnson & Johnson – Advisory Committee/Board Member, Grant/Research Support. Odyssey Therapeutics – Advisor or Review Panel Member. Pfizer – Advisor or Review Panel Member. Sanofi – Advisor or Review Panel Member. Spyre Therapeutics – Advisor or Review Panel Member.
Hansol Kang, MD1, Natalie Morris, MD2, Christine Chen, MD1, Hiba Hameed Chagla, MBBCh3, James Lewis, MD, MSCE4. P5427 - Effectiveness of Emergency Department Risk Calculators in Triaging Need for Urgent Abdominal Imaging for Patients With Crohn’s Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
