693 Risk Factors for and Frequency of Steroid Utilization in Inflammatory Bowel Disease Patients Seen in the Emergency Department

Abstract

INTRODUCTION: Although biologics and immunomodulators are commonly prescribed as maintenance therapy in patients with inflammatory bowel disease (IBD), steroids continue to be prescribed during acute flares and in refractory disease. There are significant risks associated with steroids and strategies are needed to decrease their utilization and optimize the care of IBD patients. Our aim was to identify the risk factors for and frequency of steroid utilization in IBD patients seen in our ER. METHODS: A retrospective analysis of IBD patients seen at Houston Methodist Hospital ER from 2014 to 2017 was performed using ICD codes to identify patients with Crohn's disease, ulcerative colitis or indeterminate colitis from the electronic medical record. There were 559 unique patients with 1489 unique visits confirmed after charts were individually reviewed for accuracy. Data was collected on demographics including age, sex, and ethnicity; medications (biologic, immunomodulators, and steroids); and imaging (CT of the abdomen/pelvis). Primary reason for the ER visit, and whether steroids were given specifically for IBD was documented. RESULTS: Of the 559 patients with ER visits, 61% were female with an average age of 50 (range 18-95). There were 65% with Crohn's disease, 34% with ulcerative colitis, and less than 1% had indeterminate IBD. Of these, 23% were on a biologic and 15% on an immunomodulator. Steroids were given for IBD during the ER visit or after hospital admission in 152 unique patients (27%), during 236 visits (16%). Among these patients, the average age was 44, 56% were female, 67% had Crohn's disease, 32% ulcerative colitis, 31% were on a biologic, and 24% an immunomodulator. Increasing age was associated with decreased steroid use, P = 4.039 × 10-09, R -0.00084. Males were more likely to be given steroids, P = 0.005, R = 0.048, as were those on a biologic, P = 0.001, R = 0.059, or immunomodulator, P = 2.617 × 10-16, R = 0.131. Steroid use was also more common in those with IBD as the primary reason for the ER visit, P = <2.2 × 10-16, R = 0.228. CONCLUSION: Steroid use during ER and hospital admissions in our IBD population was found to be common despite the increasing availability of alternative medications. However, steroid use was associated with biologic and immunomodulator use, suggestive that the ongoing utilization tends to occur in patients with more severe disease. Steroid use was also found to be more common in male patients, and in those of younger age which may be explained by increased use at diagnosis.