488 National Trends and Outcomes of Irritable Bowel Syndrome Presenting to Emergency Departments: Results From the Nationwide Emergency Department Sample (NEDS) Database

Abstract

INTRODUCTION: Irritable bowel syndrome (IBS) is a chronically relapsing disease that causes gastrointestinal discomfort with diarrhea and/or constipation in a large group of Americans. Estimates of IBS disease burden in emergency departments (ED) are lacking. We sought to investigate IBS emergency department visits nationally, patient demographics and hospitalization trends from 2009-2014 using Nationwide Emergency Department Sample (NEDS) database. METHODS: The Nationwide Emergency Department Sample database was used to extract data from 2009 to 2014 for patients who visited the ED with a primary diagnosis of irritable bowel syndrome. International Classification of Diseases (ICD-9-CM) were used to identify patients; Irritable bowel syndrome (ICD-9-CM: 564.1). The 2009-2014 NEDS data was used to study the incidence of ED visits, patient/hospital factors, inpatient charges, length of hospitalization and discharge from hospital to home. RESULTS: There were 189,210 (0.02%) ED visits identified with a diagnosis of IBS among a total of 795,980,104 ED visits between 2009-2014 in the NEDS database. Most patients were female (n = 143247.6, 75.8%) with a mean age of 42.4 years. The rate of ED visits decreased from 10.2 per 100,000 in 2009, to 9.4 per 100,000 in 2014 (decrease of 8%; z = -1.691, P = 0.091). The majority of patients had private insurance (n = 68687, 36.3%) followed by Medicare (n = 43272, 22.9%) and Medicaid (n = 41737, 22.1%). Uninsured patients presenting with IBS to the ED constituted 15% (n = 28392) of the study population. Patients presented with IBS in far greater numbers to urban EDs (n = 150148, 79.4%) compared to rural EDs (n = 39062, 20.6%). Most were discharged from the ED (n = 134616.9, 71.1%) while 28.9% (n = 54593.5) patients were admitted. Hospitalized patients had a decrease in mean length of stay from 3.64 days in 2009 to 3.53 days in 2014; however, the mean inpatient charges increased from $20,823 in 2009 to $27,649 in 2014 (increase of 32.8%). CONCLUSION: Irritable bowel syndrome emergency department visits remained relatively constant between 2009 and 2014 while nearly 30% of patients were admitted. Despite unchanged hospital length of stay, hospitalization costs appear to be increasing. Better outpatient management of irritable bowel syndrome is needed to avoid emergency department visits and rising inpatient costs.