Tawfik Khoury1,2,3,4, Saleh Daher1, Muhammad Massarwa1, David Hakimian1, Ariel A Benson1, Elez Viener1, Raymond Farah4,5, Amir Mari2, Wadi Hazou1, Anas Kadah3,4, Wisam Sbeit3,4, Mahmud Mahamid2, Eran Israeli1. 1. Institute of Gastroenterology and Liver Diseases, Department of Medicine, Hadassah - Hebrew University Medical Center, Jerusalem. 2. Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth. 3. Institute of Gastroenterology and Liver Diseases, Galilee Medical Center, Naharia. 4. dFaculty of Medicine in the Galilee, Bar-Ilan University, Safed. 5. Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
Abstract
BACKGROUND AND AIMS: A majority of acutely ill Crohn's disease [CD] patients who present to Emergency Department [ED] will undergo an abdominal CT to rule out disease complications. We aimed to generate a simple non-invasive scoring model to predict the presence of an intra-abdominal abscess in CD patients in the ED. METHODS: We performed a retrospective case-control study at four Israeli hospitals from January 1, 2010 to May 30, 2018. Inclusion criteria included patients with an established diagnosis of CD that had cross-sectional abdominal imaging performed. A total of 322 patients were included, and 81 [25%] were diagnosed with an intra-abdominal abscess. RESULTS: In univariate analysis, ileo-colonic location (odds ratio [OR] 1.88, p = 0.0148), perianal CD [OR 7.01, p = 0.0004], fever [OR 1.88, p = 0.0247], neutrophil-to-lymphocyte ratio [OR 1.12, p < 0.0001], and C-reactive protein [OR 1.10, p < 0.0001] were significantly associated with abscess formation, whereas current use of corticosteroids was negatively associated with abscess formation [OR 0.46, 95% CI, 0.2-0.88, p = 0.0192]. We developed a diagnostic score that included five parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of ≤7 was associated with a negative predictive value [NPV] of 93% for abscess formation, whereas a high cut-off score of >9 was associated with a positive predictive value of 65%. We validated this score with an independent cohort [area under the curve of 0.881 and NPV of 98.5%]. CONCLUSION: We recommend incorporating this score as an aid for stratifying acutely ill CD patients in the ED with low or high probability of the presence of an intra-abdominal abscess.
BACKGROUND AND AIMS: A majority of acutely ill Crohn's disease [CD] patients who present to Emergency Department [ED] will undergo an abdominal CT to rule out disease complications. We aimed to generate a simple non-invasive scoring model to predict the presence of an intra-abdominal abscess in CDpatients in the ED. METHODS: We performed a retrospective case-control study at four Israeli hospitals from January 1, 2010 to May 30, 2018. Inclusion criteria included patients with an established diagnosis of CD that had cross-sectional abdominal imaging performed. A total of 322 patients were included, and 81 [25%] were diagnosed with an intra-abdominal abscess. RESULTS: In univariate analysis, ileo-colonic location (odds ratio [OR] 1.88, p = 0.0148), perianal CD [OR 7.01, p = 0.0004], fever [OR 1.88, p = 0.0247], neutrophil-to-lymphocyte ratio [OR 1.12, p < 0.0001], and C-reactive protein [OR 1.10, p < 0.0001] were significantly associated with abscess formation, whereas current use of corticosteroids was negatively associated with abscess formation [OR 0.46, 95% CI, 0.2-0.88, p = 0.0192]. We developed a diagnostic score that included five parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of ≤7 was associated with a negative predictive value [NPV] of 93% for abscess formation, whereas a high cut-off score of >9 was associated with a positive predictive value of 65%. We validated this score with an independent cohort [area under the curve of 0.881 and NPV of 98.5%]. CONCLUSION: We recommend incorporating this score as an aid for stratifying acutely ill CDpatients in the ED with low or high probability of the presence of an intra-abdominal abscess.
Authors: Belinda De Simone; Justin Davies; Elie Chouillard; Salomone Di Saverio; Frank Hoentjen; Antonio Tarasconi; Massimo Sartelli; Walter L Biffl; Luca Ansaloni; Federico Coccolini; Massimo Chiarugi; Nicola De'Angelis; Ernest E Moore; Yoram Kluger; Fikri Abu-Zidan; Boris Sakakushev; Raul Coimbra; Valerio Celentano; Imtiaz Wani; Tadeja Pintar; Gabriele Sganga; Isidoro Di Carlo; Dario Tartaglia; Manos Pikoulis; Maurizio Cardi; Marc A De Moya; Ari Leppaniemi; Andrew Kirkpatrick; Vanni Agnoletti; Gilberto Poggioli; Paolo Carcoforo; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2021-05-11 Impact factor: 5.469