Assessing Clinical Appropriateness: A retrospective audit of CTEs performed in St. John’s, Newfoundland and Labrador, during 2022.

Abstract

Objectives: Computed tomography enterography (CTE) is an abdominopelvic computed tomography specifically designed to evaluate the small bowel. Guidelines exist regarding what clinical situations warrant CTE. This study intends to assess how CTE is currently used locally in St. John’s, Newfoundland and Labrador (NL) and compare the results to the literature to determine whether CTEs are being requested following best practices. Such results will inform referring healthcare providers as to whether they are requesting CTE appropriately.

Methods: This study consisted of a retrospective audit of all CTEs (422) performed in St. John’s, NL in 2022. Extracted information included the patient’s clinical history, age and sex, and results of the imaging study.

Results: 114 studies were requested to investigate iron deficiency anemia, of which 92 did not identify a lesion to account for the patient’s symptoms; 13 showed small bowel angiodysplasia. 92 studies were ordered to investigate the small bowel in patients with known Crohn’s diagnosis; 56 identified findings of active disease. 79 studies were ordered to investigate suspected small bowel inflammatory disease; 56 demonstrated no evidence of the same. 28 studies were ordered to investigate vascular symptomatology, of which 27 did not localize a small bowel cause.

Conclusions: CTE is, undoubtably, a valuable imaging modality to visualize the small bowel. Most of the clinical indications prompting CTE requests within the St. John's region aligned with published indications for CTE referral. However, the majority of studies did not identify a small bowel cause for the patient’s symptoms.