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

## TL;DR

A Canadian survey found that physicians differ in their views on using CT scans for IBD patients in emergency departments, which could guide better imaging practices.

## Contribution

The study reveals discrepancies in physician perceptions of CT utility for IBD in the ED, offering insights for targeted education.

## Key findings

- Gastroenterologists were less likely to recommend CT for non-obstructive IBD presentations compared to emergency physicians and surgeons.
- Emergency physicians and surgeons overestimated IBD complication detection rates via CT compared to gastroenterologists.
- Most physicians felt more comfortable diagnosing inflammation without CT than diagnosing complications without it.

## Abstract

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.

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.

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.

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.