Abstract
Patients with Crohn’s disease (CD) are frequently subject to symptoms causing them to seek medical care in emergency departments (ED). Recurrent ED visits are frequent after initial discharge. We aimed to identify the characteristics of patients with Crohn’s who tend to have recurrent visits to the ED. We created an electronic data repository of all patients with inflammatory bowel diseases who visited the ED in our tertiary medical center during the period 2012–2018. For this study, we retrieved consecutive Crohn’s patients who presented with CD-related symptoms to the ED and were eventually discharged. Patients who returned to the ED in 7 and 30 days were compared with those who did not. Overall, 2299 patients visited our ED with complaints related to Crohn’s disease exacerbation or complication. A total of 1259 (60% of the adult patients) were admitted for hospitalization. Of the 632 (33%) who were discharged from the ED, 53 (8.4%) and 110 (17.4%) re-visited the ED, in 7 and 30 days from discharge, respectively. In multivariable analysis, tachycardia (odds ratio (OR) = 2.19, 95% confidence interval (CI): 1.11–4.33, p value = 0.02), elevated alkaline phosphatase (OR = 2.09, 95% CI: 1.07–4.07, p value = 0.02), and hyponatremia (OR = 2.52, 95% CI: 1.24–5.10, p value = 0.01) were associated with revisiting the ED within 7 days. Tachycardia (OR 2.88 (95% CI 1.33–6.2)), anemia (OR 2.44 (95% CI 1.24–4.8)), and elevated alkaline phosphatase (OR 2.68 (95% CI 1.25–5.78)) were independently associated with ED returns in 30 days. Knowing these risk factors may assist in minimizing the burden of recurrent ED visits among patients with CD.
Highlights
Crohn’s disease (CD) is a chronic disease characterized by transmural inflammation throughout the gastrointestinal tract
We found that male gender (p value < 0.01), tachycardia (p value < 0.01), higher intensity of pain (>3 in numerical pain scale of 0–10) (p value < 0.01), hypoalbuminemia (p value = 0.03), hyponatremia (p value < 0.01), and anemia were associated with emergency departments (ED) re-visit in 30 days (Table 3)
Visits to the ED are a major issue in coping with inflammatory bowel diseases (IBD), for both patients and health systems
Summary
Crohn’s disease (CD) is a chronic disease characterized by transmural inflammation throughout the gastrointestinal tract. Many patients with CD experience exacerbations and complications of the disease. Several studies have previously investigated the burden and rates of emergency department (ED) visits by patients with IBD and found some inconsistency regarding trends in ED use among IBD patients. While some reported high and stable trends of ED utilization [11,12], a study conducted in South Korea reported that the proportion of patients with CD visiting the ED declined from 19.2% in 2007 to 11.3% in 2014, notably with the incline in the use of biologics from 0.0% to 19.2% [10]. The recurrent attendance of the ED carries a detrimental impact in terms of economic cost, psychological stress and physical burden, as well as a delay in the diagnosis of exacerbations and complications. There are hitherto no studies aiming to characterize patients with CD who are at risk of returning to ED after being discharged. We aimed at defining the risk factors associated with recurrent visits to the ED
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