Perceived value of computed tomography imaging for patients with inflammatory bowel disease in the emergency department: a Canadian survey

Background There are high rates of computed tomography (CT) utilization in the emergency department (ED) for patients with inflammatory bowel disease (IBD), despite guidelines recommending judicious use. We performed a national survey to better understand perceptions and practice patterns of Canadian physicians related to CT imaging in the ED.Methods Our survey was developed by a multistep iterative process with input from key stakeholders between 2021 and 2022. It evaluated Canadian gastroenterologists', surgeons', and emergency physicians' (1) perceived rates of IBD findings detected by CT, (2) likelihood of performing CT for specific presentations and (3) comfort in diagnosing IBD phenotypes/complications without CT.Results A total of 208 physicians responded to our survey: median age 44 years (IQR, 37-50), 63% male, 68% academic, 44% emergency physicians, 39% gastroenterologists, and 17% surgeons. Compared with emergency physicians and surgeons, gastroenterologists more often perceived that CT would detect inflammation alone and less often IBD complications. Based on established rates in the literature, 13 (16%) gastroenterologists, 33 (40%) emergency physicians, and 21 (60%) surgeons overestimated the rates of at least one IBD complication. Although most physicians were more comfortable diagnosing inflammation compared to IBD complications without CT, gastroenterologists were significantly less likely to recommend CT imaging for non-obstructive/penetrating presentations compared with emergency physicians and surgeons with results that varied by IBD subtype.Conclusion This national survey demonstrates differences in physician perceptions and practices regarding CT utilization in the ED and can be used as a framework for educational initiatives regarding appropriate usage of this modality. Many people with intestine problems go to the emergency room and get special pictures called computed tomography scans. These pictures can be helpful, but they cost a lot, use radiation, and impact the environment. We asked different types of doctors why they ordered these scans. Gastroenterologists, who know a lot about intestine issues, often thought the scans would find only inflammation, not other problems. Emergency doctors and surgeons had different ideas. Sixteen percent of gastroenterologists, 40% of emergency doctors, and 60% of surgeons thought these scans found more complications than they really did. Most doctors feel okay diagnosing intestine issues without using these scans. Gastroenterologists are less likely to ask for scans if patients in the emergency room do not have signs of intestine problems. Our survey helps us understand why doctors order these scans. This information will help create programs to teach doctors when it is right to use scans.