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Characteristics and outcomes of acute colitis diagnosed on cross-sectional imaging presenting via the emergency department in an Irish academic medical centre

  • J O’ConnellEmail author
  • S Keohane
  • A McGreal-Bellone
  • P McDonagh
  • S Naimimohasses
  • U Kennedy
  • C Dunne
  • K Hartery
  • J Larkin
  • F MacCarthy
  • J Meaney
  • S McKiernan
  • S Norris
  • D O’Toole
  • D Kevans
Original Article
  • 12 Downloads

Abstract

Background and aims

A significant proportion of patients presenting to the Emergency Department with gastrointestinal symptoms that result in cross-sectional imaging receive a radiological diagnosis of colitis. We aimed to review the characteristics, outcomes, and final diagnoses of new emergency department presentations with colitis diagnosed on cross-sectional imaging.

Methods

A radiology database was interrogated to identify patients admitted from the Emergency Department of St James’s Hospital whose cross-sectional imaging demonstrated colitis. Baseline demographic data, information on inpatient investigations, final diagnoses, and outcomes were recorded. Adverse outcomes were defined as a requirement for surgery, intensive care unit (ICU) stay, or mortality

Results

A total of 118 patients, 67% female, were identified with a median age of 64 years (range 16.9–101.2). Median (range) admission duration was 10 days (1–241). Final colitis diagnoses were infectious (28%), undefined (27%), reactive (18%), inflammatory bowel disease (11%), ischaemic (9%), chemotherapy-associated (3%), diverticular (3%), and medication-associated (1%). Colonic perforation, colectomy, and mortality occurred in 1%, 5%, and 13% of the cohort respectively. On univariate analysis, low haemoglobin, low albumin, high lactate, and male gender were associated with adverse outcomes with the following odds ratios (OR) and 95% confidence intervals (95%CI) were low haemoglobin 1.49 [1.15–1.92] P = 0.002, low albumin 1.16 [1.07–1.25] P = 0.0002, lactate 1.65 [1.13–2.42] P = 0.009, and male gender 3.09 [1.23–7.77] P = 0.019. On multivariate analysis, male gender was associated with adverse outcomes.

Conclusion

Patients presenting to the Emergency Department with a colitis, requiring an abdominal CT are a heterogenous group with a proportion having concomitant intra-abdominal pathology resulting in critical illness. Hence their is a significant morbidity and mortality observed in this cohort which should not be extrapolated to a general population of patients presenting with colitis. In this cohort of patients, anaemia, hypoalbuminaemia, and elevated lactate in patients presenting to the ED with acute colitis are significantly associated with adverse outcomes. Early recognition of these prognostic factors may identify the cohort of patients who are best managed in a high-dependency setting.

Keywords

Colitis Computerised tomography Cross-sectional imaging Infectious colitis 

Notes

Compliance with ethical standards

Ethical approval for the study was obtained from Institutional Research Ethics Boards according to the 1964 declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Royal Academy of Medicine in Ireland 2020

Authors and Affiliations

  • J O’Connell
    • 1
    Email author
  • S Keohane
    • 1
  • A McGreal-Bellone
    • 1
  • P McDonagh
    • 1
  • S Naimimohasses
    • 1
  • U Kennedy
    • 1
  • C Dunne
    • 1
    • 2
  • K Hartery
    • 1
    • 2
  • J Larkin
    • 2
    • 3
  • F MacCarthy
    • 1
    • 2
  • J Meaney
    • 2
  • S McKiernan
    • 1
    • 2
  • S Norris
    • 1
    • 2
  • D O’Toole
    • 1
    • 2
  • D Kevans
    • 1
    • 2
  1. 1.Department of GastroenterologySt James’s HospitalDublinIreland
  2. 2.Department of Colorectal SurgerySt James’s HospitalDublinIreland
  3. 3.Department of Diagnostic ImagingSt James’s HospitalDublinIreland

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