Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA.
BACKGROUND
Inflammatory bowel disease (IBD) is a chronic, debilitating condition with high emergency department (ED) utilization. We aimed to investigate the utilization patterns of ED by IBD patients and measure hospitalization and surgical rates following ED visits.


METHODS
We conducted a cross-sectional study of adults with IBD listed as the primary ED diagnosis from the 2009 to 2011 Nationwide Emergency Department Sample. The characteristics of the IBD-related ED visits in relation to following hospitalizations and surgeries were analyzed.


RESULTS
Adult IBD patients constitute 0.09 % of the total ED visits. Crohn's disease (CD) contributed to 69 % of the IBD-ED visits. The hospitalization rate from ED was 59.9 % nationally, ranging from 56 % in west to 69 % in northeast. The most significant factors associated with hospitalization were intra-abdominal abscess [odds ratio (OR) 24.22], bowel obstruction (OR 17.77), anemia (OR 7.54), malnutrition (OR 6.29), hypovolemia/electrolyte abnormalities (OR 5.57), and fever/abnormal white cell count (OR 3.18). Patients with CD (OR 0.66), low-income group (OR 0.90), and female gender (OR 0.87) have a lower odds of getting hospitalized. Age above 65 years (OR 1.63), CD (OR 1.89), bowel obstruction (OR 9.24), and intra-abdominal abscess (OR 18.41) were significantly associated with surgical intervention.


CONCLUSION
The IBD-related ED visits have remained relatively stable from 2009 to 2011. The presence of anemia, malnutrition, hypovolemia, electrolyte abnormalities, fever, abnormal white cell count, bowel obstruction, or intra-abdominal abscess during the ED visit was associated with hospitalization. The presence of bowel obstruction and intra-abdominal abscess was strongly associated with surgical intervention.
['Gajendran|Mahesh|M|', 'Umapathy|Chandraprakash|C|', 'Loganathan|Priyadarshini|P|', 'Hashash|Jana G|JG|', 'Koutroubakis|Ioannis E|IE|', 'Binion|David G|DG|']
D018784:Abdominal Abscess D000293:Adolescent D000328:Adult D000368:Aged D000740:Anemia D003430:Cross-Sectional Studies D004636:Emergency Service, Hospital D005260:Female D006760:Hospitalization D006801:Humans D015212:Inflammatory Bowel Diseases D007415:Intestinal Obstruction D008297:Male D044342:Malnutrition D008875:Middle Aged D016017:Odds Ratio D011203:Poverty D014481:United States D014883:Water-Electrolyte Imbalance D055815:Young Adult
Emergency department Hospitalization Crohn’s disease Regional variations Ulcerative colitis