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• W2978755470 abstract "Introduction: LGIB remains a major health care burden in the United States. Guidelines for LGIB management supports colonoscopy over imaging as a first-line therapy, as colonoscopy provides higher diagnostic and therapeutic yields. Imaging consisting of CT angiography, nuclear red blood scan and mesenteric angiogram; should be reserved for patients with severe bleeding who cannot be stabilized or prepped for a colonoscopy and those who have failed endoscopic management. Aim: To identify the prevalence and outcomes of inappropriate use of imaging; as a first-line therapy for severe active LGIB in two community hospitals. Methods: A retrospective study was conducted in patients admitted with severe LGIB from January 2014 to December 2014. Patients were assigned to four groups depending on their intervention for LGIB: Colonoscopy alone(C), colonoscopy followed by imaging (C→I), imaging alone (I), imaging followed by colonoscopy (I→C). Imaging is defined as appropriate if patients have hemodynamic instability, or have failed endoscopic management, or have refused colonoscopy, or have recent normal colonoscopy in < 3 months, or have comorbidities that can preclude colonoscopy. Data was collected to assess patients' demographics, laboratory values at the time of presentation, length of stay, cost, blood transfusion, complications and death. Results: Out of 154 patients admitted with severe LGIB, 73(47.4%) had C, 6(3.89%) had C→I, 30(19.48%) had I, 45(29.22%) had I→C. Of total 75 patients who received imaging as a first-line therapy; inappropriate indication of imaging was identified in 55 (74%) patients. They were matched to total 79 patients receiving colonoscopy as a first-line therapy (table 1). Inappropriate use of imaging was associated with higher length of stay (5.72±4.79 vs 4.38±2.66, p=0.04), higher cost (79,000±74,995 vs 60,634±50,565, p=0.002) and higher requirement of blood transfusion (61% vs 45%, p=0.04). Of total 55 patients with inappropriate use of imaging, only 15(27%) had active bleeding noted on imaging. Conclusion: Inappropriate use of imaging was noted in 74% of patients receiving imaging as a first-line therapy. Inappropriate use of imaging over colonoscopy results in higher cost, higher length of stay, and higher blood transfusion requirement; with only 27% of a diagnostic yield. Physicians should be made aware about the appropriate use of imaging in severe active LGIB. Further larger studies are warranted to support our data.Table 1: Comparison Between Colonoscopy Group and Inappropriate Use of Imaging Group for LGIB" @default.
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• W2978755470 date "2015-10-01" @default.
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• W2978755470 title "Inappropriate Use of Imaging as a First Diagnostic Tool in Severe Active Lower Gastrointestinal Bleeding (LGIB) Predicted Negative Outcomes in Key Parameters: An Experience in Two Community Hospitals" @default.
• W2978755470 doi "https://doi.org/10.14309/00000434-201510001-02304" @default.
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