P402 Prediction of emergency department re-visit among Crohn’s disease patients: a retrospective study

Abstract

Abstract Background Patients with Crohn’s disease are frequently subject to symptoms causing them to seek medical care in emergency departments (ED). Recurrent ED visits are common after initial discharge. The burden of recurrent ED visits of Crohn’s patients is high for the patient and the health care system. We aimed to identify the characteristics of patients with Crohn’s disease who return to the ED within 30 days from discharge. Methods We created an electronic data repository of all IBD patients admitted to our tertiary medical centre in the time frame 2012 – 2018. Data included tabular demographic and clinical variables, as well as free-text physician records. For this study, we retrieved consecutive Crohn’s patients who were discharged from the ED. We included only patients with complains that can be attributed to Crohn’s disease exacerbation or complication. Patients without available blood test results were excluded, as well as pregnant women and patients under 18. Patients who returned to the ED in 30 days were compared with those who did not. Results Overall, 2148 patients visited our ED with complaints related to Crohn’s disease exacerbation or complication. 1435 (67%) were admitted for hospitalisation. Six hundred and ninety-five (33%) were discharged, of them, 110 (15.8%) returned to the ED within 30 days. Male gender, tachycardia (>100 bpm), pain score >4 (using numerical pain rating scale of 0–10), Albumin <3.5 gr/dl, elevated alkaline phosphatase (>120 IU/l), hyponatremia (<135 meq/l), and anaemia (defined as less than 13.5 gr/dl for males and less than 12.0 gr/dl for females) were found to be associated with ED returns. On multivariate analysis, anaemia (OR 2.44 [95% CI 1.24–4.8]), tachycardia (OR 2.88 [95% CI 1.33–6.2]), and elevated alkaline phosphatase (OR 2.68 [95% CI 1.25–5.78]) were independently associated with ED returns. Of patients with 0, 1, 2, and 3 risk factors for ED re-visits 10%, 17%, 30%, and 33% revisited the ED within 30 days from discharge, respectively. Conclusion In our large tertiary centre cohort, recurrent ED visits within 30 days occurred in 16% of the patients. Tachycardia, anaemia and elevated alkaline phosphatase were found to be independently associated with recurrent visits. This model, if validated in prospective studies, may be implemented in order to minimise the burden of recurrent ED visits.