Emergency department utilization by haemophilia patients in United States.

Abstract

Patients with haemophilia are prone to medical emergencies. Emergency departments (ED) often do not have a haematologist on-call for consultation. The aim of this study was to determine the utilization of ED by patients with haemophilia. Retrospective review of the 'National ED Database Sample' for years 2006-2013 was performed. Patient and hospital demographics were collected. Hospital charges were projected to national levels using discharge-weighted variables. During the 8-year study period, haemophilia patients made 162 982 ED visits. This represents 0.016% of total ED visits nationwide. Children utilized ED the most. More than half of patients resided in metropolitan cities; 20% had over $63 000 annual household income. Government insurances were the largest primary payers; 30% had private insurance. In the year 2012, 4488 ED visits with 21 000 diagnoses codes were recorded. Mean age was 29 years. Cardiovascular were the most frequently reported complaints followed by injuries, haemorrhages and sepsis. Seventy percent patients were treated and released from the ED. Two patients died in ED, whereas 35 after admission to hospital. Cause of death included Sepsis (n = 26) and brain haemorrhage (n = 4). Among children, injuries were the most frequent complaints followed by joint/soft tissue disorders; fevers and central line complications. Average charge per visit at private vs. public hospital was $2988 and $2254 respectively (P = 0.03). National estimate of total charges was $60 million. Patients with haemophilia have tendency to utilize ED. Hypertension was the single most common presenting complaint in adults. No deaths were reported in children from brain haemorrhage.