• Katherine Stewart and Ashwani Kumar Sharma.
• Strong Memorial Hospital, University of Rochester, Rochester, NY, USA. Electronic address: Katherine_stewart@urmc.rochester.edu.
• Am J Emerg Med. 2021 Jan 1; 39: 60-64.

BackgroundGastrointestinal (GI) bleeding is a common patient presentation to the Emergency Department (ED) and the source can be difficult to diagnose.ProcedureComputed tomography angiography (CTA) is a new but validated modality with high sensitivity and specificity for diagnosis and treatment of GI bleeds, especially in differentiating arterial from venous bleeding. With high reported validity of CTA, some studies have suggested its ability to better triage patients in the ED and impact ED workflow and resource utilization. We evaluated the use of CTA use an academic tertiary care center ED for GI bleeding.FindingsRetrospective chart review of 1493 patient (2012-2015), one - way ANOVA, and one-tail t-test, found CTA is used significantly less (0.7%) compared to classical endoscopy (75.7%, p < .001), video capsule endoscopy (VCE)(4.8%, p < .001), tagged red blood cell scintigraphy(4.4%, p < .001), and traditional catheter-directed angiography(2.88%, p < .001). In our subset of 11 CTA cases, we found mean time (in hours) to CTA was faster than mean time to endoscopy, 31:47 [95% CI: -7:50-71:24] and 42:44 [95% CI: 18:27-67:01] respectively. The difference in means between time to CTA and time to endoscopy did not achieve statistical significance, 12:57 h [95% CI -18:51-44:45; p = .40].ConclusionWe concluded that in light of its validation against these other diagnostic modalities, CTA may be underutilized in the care of patients with GI bleeding and should be studied further to study its impact on early risk stratification, treatment, and resource utilization.Copyright © 2020 Elsevier Inc. All rights reserved.

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