Pediatrics
Subject Category: Pediatrics
Am J Gastroenterol advance online publication 18 August 2009; doi: 10.1038/ajg.2009.480
Diagnostic Ionizing Radiation Exposure in a Population-Based Sample of Children With Inflammatory Bowel Diseases
Lena Palmer MD, MSCR1, Hans Herfarth MD, PhD1, Carol Q Porter BS2, Lynn A Fordham MD3, Robert S Sandler MD, MPH1 and Michael D Kappelman MD, MPH4
- 1Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 3Department of Radiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
- 4Division of Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Correspondence: Lena Palmer, MD, MSCR, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 4162R Bioinformatics Building, Campus Box 7080, Chapel Hill, North Carolina 27599, USA. E-mail: lena_palmer@med.unc.edu
Received 24 March 2009; Accepted 16 June 2009; Published online 18 August 2009.
Abstract
OBJECTIVES:
The degree of diagnostic radiation exposure in children with inflammatory bowel diseases (IBD) is largely unknown. In this study, we describe this exposure in a population-based sample of children with IBD and determine the characteristics associated with moderate radiation exposure.
METHODS:
We ascertained radiological study use, demographic characteristics, IBD medication use, and the requirement for hospitalization, emergency department (ED) encounter, or inpatient gastrointestinal surgery among children with IBD within a large insurance claims database. Characteristics associated with moderate radiation exposure (at least one computed tomography (CT) or three fluoroscopies over 2 years) were determined using logistic regression models.
RESULTS:
We identified 965 children with Crohn's disease (CD) and 628 with ulcerative colitis (UC). Over 24 months, 34% of CD subjects and 23% of UC subjects were exposed to moderate diagnostic radiation (odds ratio (OR) 1.71, 95% confidence interval (CI), 1.36 – 2.14). CT accounted for 28% and 25% of all studies in CD and UC subjects, respectively. For CD subjects, moderate radiation exposure was associated with hospitalization (OR 4.89, 95% CI 3.37 – 7.09), surgery (OR 2.93, 95% CI 1.59 – 5.39), ED encounter (OR 2.65, 95% CI 1.93 – 3.64), oral steroids (OR 2.25, 95% CI 1.50 – 3.38), and budesonide (OR 1.80, 95% CI 1.10 – 3.06); an inverse association was seen with immunomodulator use (OR 0.67, 95% CI 0.47 – 0.97). Except for oral steroids and immunomodulators, similar relationships were seen in UC.
CONCLUSIONS:
A substantial proportion of children with IBD are exposed to moderate amounts of radiation as a result of diagnostic testing. This high utilization may impart long-term risk, given the chronic nature of the disease.
