Emergency Room Visits Research Articles

Characteristics of Patients with Hereditary Angioedema Who Reduced Lanadelumab Treatment Administration Frequency: A Retrospective Observational Study of US Claims Data.

Lanadelumab is the only long-term prophylaxis indicated for reduced administration frequency in patients with hereditary angioedema who have been well controlled for > 6 months. Understanding the characteristics of patients who reduce administration frequency will help identify populations where frequency modifications may be appropriate. We aimed to describe characteristics of patients who did and did not reduce lanadelumab administration frequency to inform real-world dosing regimens, and characteristics indicative of sustained frequency reduction. A retrospective observational study using healthcare insurance data in the USA from the Merative™ MarketScan® Commercial and Medicare Databases identified patients persistent on lanadelumab for ≥ 18 months. Reduced administration frequency was defined as a ≥ 25% decrease in lanadelumab costs during months 7-12 or 13-18 versus 0-6. Hereditary angioedema attack triggers/symptoms and hereditary angioedema-related healthcare encounters, treatment, and costs were assessed. Of 54 identified patients, 25 reduced administration frequency. Two patients returned to initial dosing frequency during months 13-18 after reducing during months 7-12. Patients who reduced administration frequency experienced fewer hereditary angioedema attack triggers/symptoms before lanadelumab initiation (baseline) and during months 0-6 than those who did not; they also had a lower mean number of hereditary angioedema-related inpatient admissions, emergency room visits, and outpatient visits during baseline, had fewer claims for acute treatment (60.0% vs 65.5%) and prior long-term prophylaxis (20.0% vs 27.6%), and had lower mean hereditary angioedema treatment costs at baseline ($139,520 vs $233,815) than those who did not. This real-world analysis suggests that patients with less frequent hereditary angioedema-related healthcare encounters, lower disease activity, and lower costs within 6 months before lanadelumab initiation are more likely to achieve reduced dosing frequency.

Distinct phenotypes of patients and healthcare resource utilization after hospitalization for COVID-19: an observational study

BackgroundLittle is known about postdischarge healthcare resource use (HCU) among patients hospitalized for coronavirus disease 2019 (COVID-19). The objective was to identify distinct profiles of patients based on postdischarge cares.MethodsThis was a retrospective cohort study using the French National Health System claims database. We followed up all patients hospitalized for COVID-19 between 2020/02/01 and 2020/06/30 for 6 months; the discharge date was the index date. We excluded patients who died during the index stay or within 30 days after discharge. We described patients’ HCU over 5 months from day 31 after the index date to the end of follow-up, i.e., the post-COVID-19 period. We described the sociodemographic and clinical characteristics of the participants and 44 selected types of HCU, including medical and emergency room visits, medications, medical and biological tests, oxygen therapy, rehabilitation, rehospitalization, nurse visits, and sick leave. We performed Ward’s ascendant hierarchical clustering (AHC) analysis to identify groups of patients with similar post-COVID-19 HCU and described HCU and clinical characteristics by cluster.ResultsThe study population included 68,822 patients (median age: 64.8 years, 47% women). Eight clusters of patients were identified, each comprising between 1,163 and 35,501 patients. Four clusters were characterized by older patients and high proportions of comorbidities, i.e. cancer (cluster 3), mental disorders (cluster 4), cardiac insufficiency (cluster 5) and respiratory failure (cluster 6). Cluster 8 was characterized by younger patients, often obese and with low mortality. Another cluster was characterized by complex index stays (cluster 7) and a last cluster (cluster 2) by specific medical contacts and therapy. The main cluster (cluster 1, n = 35,501) was similar to the overall study population. The duration and complexity of the index stay also varied across clusters.ConclusionsBased on HCU data, AHC identified 8 clinically relevant profiles of patients surviving the acute episode of COVID-19 hospitalization. The clusters illustrate the many impacts of COVID on the health status of infected patients and may help anticipate future needs of care in a similar context.

Comorbidities and Healthcare Utilization Among Young Adults With Congenital Heart Defects by Down Syndrome Status-Congenital Heart Survey to Recognize Outcomes, Needs, and wellbeinG, 2016-2019.

Almost half of individuals born with Down syndrome (DS) have congenital heart defects (CHDs). Yet, little is known about the health and healthcare needs of adults with CHDs and DS. Therefore, we examined comorbidities and healthcare utilization of this population. Data were from the 2016-2019 Congenital Heart Survey to Recognize Outcomes, Needs, and well-beinG (CH STRONG), a survey of 19-38-year-olds with CHDs identified through birth defects registries in Arkansas, Arizona, and Atlanta. Outcome estimates were standardized to the CH STRONG eligible population. Multivariable Poisson regression generated adjusted prevalence ratios (aPRs) for associations between DS and each outcome, adjusting for covariates, including CHD severity. Among 1500 respondents, 9.1% had DS. Compared to those without DS, respondents with DS were more commonly male (55.5% vs. 45.0%), < 25 years old (51.8% vs. 42.7%), non-Hispanic White (72.3% vs. 69.3%), and publicly insured (77.4% vs. 22.8%; all p < 0.05). Of adults with CHDs and DS, 5.5% had cardiac comorbidities, 19.3% had emergency room (ER) visits, 6.2% had hospital admissions, and 1.2% had cost-related delays in care in the last year; 0.1 to 0.6 times lower than adults with CHDs without DS. Additionally, 26.7% had non-cardiac comorbidities (aPR = 1.25 [0.92-1.72]), most commonly sleep apnea (13.7% vs. 3.2%, aPR = 3.67 [2.02-6.67]). Receipt of cardiology care in the last 2 years was similarly low (52.7% vs. 44.7%). Adults with CHDs and DS comprise a substantial percentage of adults with CHDs and have unique health and healthcare needs. Half of adults with CHDs and DS are not receiving recommended routine cardiac care.

Immunotherapy-Related Adverse Events and Clinical Outcomes in Adult Solid-Tumor Patients Admitted to an Onco-Hospitalist Medicine Service

Background/Objectives: Few studies have focused on patients with immune-related adverse events (irAEs) after immune checkpoint inhibitor (ICI) treatment who were cared for primarily by hospitalists. The objective of our study was to describe the patterns and outcomes of adult solid-tumor cancer patients admitted to our onco-hospital medicine service. Methods: We retrospectively reviewed patients with solid tumors who received ICIs and were admitted to our service in 2021–2022 with an irAE and compared them to a control group (IOTOX vs. NO IOTOX, respectively). The primary outcome was the patterns of irAEs requiring hospitalization; secondary outcomes included 30-day emergency room visit, readmission, and 30-day mortality. Results: There were 144 patients in the IOTOX group and 286 controls. The most common tumor type was lung and thoracic malignancies (62, 43.1%). The most common ICI causing the irAEs was pembrolizumab (66, 45.8%). The most common irAEs were pneumonitis (49, 34%), colitis (28, 19.4%), hepatitis (18, 12.5%), and myocarditis (16, 11.1%). Of the 144 patients, eight (6%) died from the hospitalization irAE. Fifteen (15.6%) had an ER visit within 30 days due to the same irAE, and thirteen (13.7%) were readmitted. Survival at 30 days after discharge did not differ significantly between groups. Conclusions: Despite many patients having severe irAEs and irAEs associated with higher mortality, they generally had a favorable outcome compared to the literature.

Combining Transversus Abdominis Plane and Rectus Sheath Blocks in Open Inguinal Hernia Surgery Anesthesia: A Retrospective Cohort Analysis.

Lichtenstein hernia repair is a common surgical procedure. Previously, combined rectus sheath (RS) and transversus abdominis plane (TAP) blocks have been shown to be beneficial in laparoscopic inguinal hernia surgery. Our hypothesis is that combining the two blocks will also be beneficial in open Lichtenstein hernioplasty day-case procedures. This retrospective study analyzed data from 186 patients undergoing inguinal hernia surgery chosen using the propensity score matching. Primary endpoint was intraoperative and postoperative opioid consumption. Secondary endpoints were conversion of the anesthetic method, postoperative nausea and vomiting (PONV), unscheduled hospitalization or emergency room visits, perioperative duration, analysis of the patient flow, and surgical complications. Ninety-three patients treated with the blocks (study group) and 93 controls were analyzed. The study group had significantly lower opioid use in the operating room (2.5-7.5mg vs. 5.0-7.5mg and p<0.01) and in the recovery room (0.0-2.0mg vs. 1.0-10.6mg and p<0.0001). There was no difference in postoperative recovery room times nor in the patient flow. Postoperative hospitalization due to pain was 9.1% in the control group, whereas no patients in the study group were hospitalized (p<0.01). RS and TAP blocks reduce postoperative pain in inguinal hernia surgery, resulting in significantly lower postoperative opioid use and hospitalization rates. The blocks are technically easy and quick to perform and should be considered for pain management in inguinal hernia day-case surgery.

Job loss and reemployment of newly diagnosed people with epilepsy: A nationwide cohort study.

Epilepsy has negative socioeconomic impacts on those affected, resulting not only from actual disability but also from social stigma. However, longitudinal studies examining occupational consequences following an epilepsy diagnosis are limited. We aimed to investigate the occupational outcomes of newly diagnosed epilepsy among Korean employees. We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service database. We included newly diagnosed people with epilepsy (PWE) aged 25 to 54 years, identified by diagnostic codes and antiseizure medication (ASM) prescriptions, who were employed at diagnosis between 2004 and 2018. The employment status of PWE was determined based on their enrollment in the employer-provided health insurance scheme. We analyzed the rates of job loss and reemployment, associated factors, and income changes following diagnosis. Among the 13 122 newly diagnosed PWE, the overall first-year job loss rate across the study period was 21.7%, which was 1.62-2.54 times higher than that of the general population for each year. The excesses of job loss among PWE in safe occupations were comparable to those in safety-sensitive occupations. Central nervous system illness (adjusted hazard ratio [aHR] = 1.12), psychiatric disease (aHR = 1.19), ≥2 emergency room visits or hospitalizations (aHR = 3.00), and ≥4 ASM attempts (aHR = 1.26) increased the risk of job loss. Among individuals who lost their job during the first year, 22.4% were reemployed within 1 year, with similar risk factors hindering reemployment. The income distribution of regained jobs showed a downward shift compared to previous jobs. Newly diagnosed PWE were at risk of job loss, irrespective of the occupational hazards related to seizures. Poor disease control and comorbidities partially contributed to unemployment. Alongside active seizure management, guidance for suitable occupations and the implementation of tailored restrictions based on occupational risk stratification are imperative to improve the job security of PWE.

P0502 Impact of Endoscopic and Histologic Activity on Disease Relapse in Ulcerative Colitis: 3-year and 5-year follow-up

Abstract Background Endoscopic healing in patients with ulcerative colitis predicted higher rates of clinical remission at 12 months follow-up. Meanwhile, active histologic disease did not affect time to clinical relapse in patients with UC who achieved endoscopic remission while the presence of basal plasmacytosis was associated with relapse. [1] We aim to evaluate the impact of baseline endoscopic and histological healing on long-term clinical relapse as well as the rates of UC-related emergency room (ER) visits, hospitalizations and surgery. Methods This prospective observational study was conducted at the Inflammatory Bowel Disease (IBD) Centre of McGill University Health Centre (MUHC) July 2012 to July 2020 and included all adult UC patients undergoing a colonoscopy with biopsies for disease assessments. Patient must have been in clinical remission with a stable dose of medication for at least 3 months prior to enrolment. Patients were followed every 3 months in the first year then every 6-12 months to assess disease relapse, defined as a partial Mayo score (PMS) &amp;gt;2. Active endoscopic disease was defined as Mayo endoscopic score (MES) of 2 or 3. Active histological disease was defined as a Geboes score ≥3.1 (epithelial neutrophils with or without crypt destruction/erosions). Results A total of 253 patients were included in this study. At the 3-year follow-up, baseline active endoscopic and histological disease did not predict clinical relapse. However, baseline endoscopy with a EMS of 0 (compared to 1-3) showed a trend towards significance in predicting relapse (P = 0.08). Multivariate analysis adjusting for age, gender, height, and smoking status remained non-significant (P = 0.0837, 95% CI 0.29–1.08). At 5 years, baseline histological activity did not predict risk of clinical relapse, however, endoscopy with EMS 0 significantly predicted clinical relapse (P = 0.0080), with multivariate analysis confirming this (P = 0.0110, 95% CI 0.27–0.84). Baseline endoscopy with EMS 1-3 was linked to increased ER visits at 3 years (P = 0.02), but not at 5 years (P = 0.7618). Histological disease activity was not linked to increased ER visits at 3 and 5 years. Neither baseline endoscopy nor histology predicted the risk of hospitalisation or surgery at either follow-up (P &amp;gt; 0.05). Conclusion Active histologic disease did not predict long-term clinical relapse at 3- or 5-years point. On the other hand, baseline endoscopic activity of EMS of 0 compared to 1-3, only predicted clinical relapse at 5 years and IBD-related ER visits at 3 years. This long-term follow up data questions the additional role of histology in patient with complete endoscopic healing.

P0982 Efficacy of upadacitinib in patients with Crohn’s disease and an ostomy: A matched retrospective real-world cohort analysis

Abstract Background Upadacitinib (UPA) is an oral selective Janus kinase inhibitor approved for the management of moderate-to-severe Crohn’s disease (CD). One in ten CD patients may need a permanent ostomy (colostomy or ileostomy) during their disease course, and this may impact the efficacy of UPA, given its extended-release formulation. However, there is no data available in this population since patients with an ostomy are excluded from registrational CD trials. This study addresses this gap by comparing the real-world clinical effectiveness of UPA in CD patients with and without ostomy. Methods This retrospective cohort study analyzed data from the TriNetX US Collaborative Network of sixty-eight tertiary institutions, to examine adult (≥18 years) CD patients treated with UPA from May 19th, 2023 (FDA approval date) to October 31st, 2024. Patients were categorized based on presence or absence of an ostomy during the previous 5 years, after exclusion of patients with rheumatologic disease indications for UPA usage. A 1:1 propensity score matching (PSM) was performed to balance cohorts on demographics, baseline comorbidities, and CD severity indicators (CD phenotype, extraintestinal manifestations, concurrent corticosteroid and other biologics usage, hemoglobin, and body weight). Cox proportional hazards model estimated hazard ratios (HRs) in matched cohorts for clinical effectiveness as a composite outcome (corticosteroid use, hospitalizations, emergency room visits) and secondary individual outcomes, at one year post-treatment, with a significance threshold set at p &amp;lt; 0.05. Results The study sample of CD patients on UPA included 170 with and 1,428 without a prior ostomy. There were 144 patients in each cohort after PSM. Baseline characteristics of the cohorts are shown in Figure 1. After PSM (Figure 2), there were no significant differences between patients with CD on UPA, with and without prior ostomy, for composite outcomes (HR 0.93, p = 0.64), corticosteroid use (HR 0.78, p = 0.18), hospitalizations (HR 1.13, p = 0.64), or emergency room visits (HR 0.99, p = 0.97). Additionally, no significant differences were observed in opioid use (HR 0.95, p = 0.76), switch to another advanced therapy (HR 1.62, p = 0.06), or elevated biomarkers, including CRP (&amp;gt;10 mg/L, HR 1.00, p = 0.99) and fecal calprotectin (&amp;gt;150 µg/g, HR 0.85, p = 0.63) at the 1-year follow-up. Conclusion In CD patients, UPA demonstrated similar effectiveness for clinical outcomes of corticosteroid use, hospitalizations, emergency room visits and other secondary outcomes, regardless of their ostomy status.

P1080 Early Biologic Therapy for Inflammatory Bowel Disease in Taiwan: A Single- Center Retrospective Cohort Study

Abstract Background As the "top-down" strategy gains increasing importance in the management of IBD, early biological intervention is increasingly recognized as a significant focus in clinical practice. However, compared to Western countries, limited database availability has left this issue unexplored in Taiwan. To this end, we analyzed a 10-year database from a single medical center, focusing on clinical outcomes and colectomy-free survival in patients treated with biologics. Methods In this retrospective study, we included IBD patients who had received biologic therapy for more than 6 months between February 2012 and October 2023. Early biologic therapy was defined as initiation within two years of diagnosis. The crude risk of clinical outcomes, such as colectomy, IBD-related emergency room visits, and IBD-related hospitalizations, were analyzed using Kaplan-Meier curves, log-rank test. Results A total of 115 consecutive IBD patients who received biologic therapy were enrolled, including 61 patients with UC and 54 with CD. The study was divided into two groups: the early biologic therapy group (n = 43) and the late biologic therapy group (n = 72). 64.3 % of patients were male and the mean diagnostic age was 40.5 ± 16.1 years. The mean duration of the first biologic agent use was longer in patients receiving early biologic intervention. Table 1 presents the other baseline characteristics of both cohorts. During a median follow-up of 8.8 (± 6.1 years), 29.6 % of patients visited the ER after their first biologic treatment, while 26.1 % were hospitalized due to IBD flare-ups. Additionally, eight patients required a colectomy. The analysis revealed a statistically significant difference in the cumulative survival rate for hospitalization (p = 0.048). However, no significant differences were observed in the cumulative survival rates for colectomy (p = 0.166) or emergency room visits (p = 0.048). Conclusion Early biologic therapy significantly reduces hospitalization risk in Taiwanese IBD patients. However, it shows no significant link to emergency room visits, possibly due to higher emergency care use in Taiwan. Thus, larger studies are needed to confirm its effectiveness.

P0952 Effect of a Care Pathway for Inflammatory Bowel Disease on Patient Outcomes and Healthcare Utilization: results of the IBD Value Study

Abstract Background Eight hospitals in the southwest of the Netherlands collaborate to improve care for patients with inflammatory bowel disease (IBD). This collaboration aims to deliver high quality and uniform care across the region. To achieve this, a care pathway (CP) was developed and implemented for the management of IBD with biologicals or small new molecules. The CP is a decision-support tool that provides guidelines for medication prescribing, procedures, treatment adjustments, and recommendations for follow-up. The aim of this study is to evaluate the effect of a CP on patient outcomes and healthcare utilization. Methods We designed a longitudinal multicentre non-randomised cohort study with a baseline observation period (December 2020 – December 2021) and a follow-up period (March 2022 – March 2023), in which adult patients with IBD treated with biologics or small new molecules were included (1). Outcomes were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set from electronic medical records or through validated questionnaires. Effect of the CP on these outcomes were analysed with case-mix adjusted (generalized) linear mixed models. Results A total of 1,173 patients participated in the study, with the majority being female (55%) and a median age of 45 years (IQR 33-58). Most patients had Crohn’s disease (64%). The CP was associated with a 14% increase in the probability of patient-reported disease control (p=0.54). Increases in probability were also observed for patient-reported (β=0.25, p=0.29) and biochemical remission (β=0.17, p=0.37), and the presence of active fistulas (β=0.28, p=0.44). Decreases in probability were found for biological (β=-0.04, p=0.84) and clinician-reported remission (β=-0.16, p=0.48). Emergency room visits (β=-0.32, p=0.18), hospital admissions (β=-0.28, p=0.28), and length of stay (β=-0.23, p=0.20) showed reduction, although these associations were also not significant. The CP had no effect on quality of life (β=0.01, p=0.35) or on anaemia probability (β=0.05, p=0.84). Conclusion A CP for the management of IBD with biologicals and small new molecule has clinically significant potential to reduce healthcare utilization, while improving patient-reported disease control, and biochemical remission. These results emphasize the potential of a CP to improve care for a complex disease as IBD. However, the adherence to the CP and whether these results lead to a reduction in healthcare costs, should be further investigated.

DOP102 Comparative effectiveness of risankizumab vs. ustekinumab in bio-naïve Crohn's disease patients: A real-world multicentre retrospective cohort study

Abstract Background The SEQUENCE trial, in bio-exposed Crohn's disease (CD) patients, demonstrated non-inferiority for clinical remission at 24 weeks and superiority for endoscopic remission at week 48 for risankizumab (RZB) compared to ustekinumab (UST). However, this comparison has not been adequately explored in bio-naive CD patients. Our study aimed to compare the clinical effectiveness among bio-naive CD patients treated with RZB vs. UST in a real-world setting, using data from a US-based multicenter cohort. Methods This retrospective cohort study utilized data from the TriNetX US Collaborative Network, comprising sixty-eight tertiary institutions, to examine adult (≥18 years) bio-naive CD patients initiated on RZB or UST from June 17th, 2022 (FDA approval date) to October 31st, 2024. Patients with prior advanced therapy usage and those with approved rheumatologic disease indications for RZB/UST were excluded. A 1:1 propensity score matching (PSM) analysis was conducted to balance cohorts on demographics, baseline comorbidities, and indicators of CD severity, including CD phenotype, extraintestinal manifestations, concurrent corticosteroid use, hemoglobin, and body weight. Cox proportional hazards models estimated hazard ratios (HRs) in matched cohorts for one-year post-treatment composite outcomes (need for corticosteroids, hospitalizations, emergency room visits, surgeries) with a priori significance threshold of p &amp;lt; 0.05. Results The study sample included 1,630 bio-naive CD patients treated with RZB and 3,105 with UST. Among patients on UST, 658 (21%) were dosed every four to six weeks, after the first dose. Baseline characteristics of the PSM RZB and UST cohorts are shown in Table 1 with 1,568 patients in each cohort. After PSM (Figure 1), there were no significant differences in composite outcome (HR 1.077, p = 0.170), corticosteroid use (HR 1.099, p = 0.110), CD-related surgery (HR 1.231, p = 0.284), hospitalization (HR 0.947, p = 0.615) or ER visits (HR 1.041, p = 0.687). Additionally, no significant differences were observed in opioid use (HR 1.062, p = 0.366), switch to different advanced therapy (HR 1.097, p = 0.468) or elevated disease biomarkers, including CRP (&amp;gt;10mg/l, HR 1.186 p = 0.101) or fecal calprotectin (&amp;gt;150 µg/g; HR 1.109, p = 0.407) at 1-year follow-up. Conclusion In this real-world experience allowing for drug optimization, no difference was observed in bio naïve patients between UST and RZB as far as clinical remission and progression of CD.

P0484 Impact of Early Aggressive Treatment on Long-term Biochemical Marker Patterns in Inflammatory Bowel Disease: A latent class mixed model

Abstract Background Inflammatory bowel disease (IBD) shows a highly variable disease course, making early identification of patients at risk for poor outcomes important for personalized treatment. This study aimed to classify the long-term disease course in patients with IBD using biochemical markers and to investigate the clinical factors associated with different disease trajectories. Methods Longitudinal data on C-reactive protein (CRP) and fecal calprotectin (FCP) levels were collected from patients in a tertiary hospital cohort between 2017 and 2023. Patients with at least two CRP and FCP tests between six months and five years after IBD diagnosis were included. Early IBD-related treatments, ER visits, and hospitalizations were defined as occurring within six months of diagnosis. A latent class mixed model (LCMM) was employed to identify the distinct subclasses based on CRP or FCP changes. Subsequently, univariate analyses and multinomial logistic regression were conducted to evaluate the relationships between different biochemical trajectories and clinical variables. Results Among the patients, 245 with CD and 635 with UC were included in the CRP model, while 256 with CD and 536 with UC were included in the FCP model. Through LCMM, a three-class model was found to be most appropriate for patients with both CD and UC: Class 1, characterized by early and sustained biochemical remission; Class 2, featuring delayed remission; and Class 3, marked by prolonged difficulty in achieving remission for over five years. In the CRP trajectory analysis, early initiation of immunomodulators (IM) in patients with CD was significantly associated with a higher probability of belonging to Class 1 (Class 2 vs. 1, odds ratio [OR] 0.344; Class 3 vs. 1, OR 0.472; p-value = 0.039). In the FCP trajectory analysis, early advanced therapy (AT) significantly increased the odds of belonging to Class 1 for patients with CD (Class 2 vs. 1, OR 0.383; Class 3 vs. 1, OR 0.220; p-value = 0.004). Conversely, no significant factors were identified in the CRP trajectory analysis for patients with UC. In UC, younger age at diagnosis (Class 2 vs. 1, OR 0.969; Class 3 vs. 1, OR 0.980; p-value = 0.004) and early IM initiation (Class 2 vs. 1, OR 2.928; Class 3 vs. 1, OR 2.698; p-value &amp;lt;0.001) were associated with higher odds of belonging to Class 2 or 3, whereas current smoking was associated with a higher likelihood of belonging to Class 1 in the FCP trajectory analysis (Class 2 vs. 1, OR 0.194; Class 3 vs. 1, OR 0.559; p-value = 0.008). Conclusion Early aggressive treatments, particularly the prompt initiation of AT in CD, may contribute to achieving long-term biochemical remission; however, similar associations were not observed in UC.

P1287 Comparative Analysis of IBD Management: Hospital Versus Community-based Care

Abstract Background Our study aimed to compare disease characteristics, medication utilization, procedures performed, and hospitalizations between IBD patients treated in hospital and community settings using the Leumit Health Service database. Methods A retrospective cohort study was conducted using data from the Leumit Health Service, comprising 3020 patients diagnosed with IBD fBetween 2010 -2019. Patients were divided based on primary care setting: hospital-based or community-based. Data included demographic characteristics, disease type, medication usage, procedures, and outcomes. Results Overall 3020 patients were included, of them 1627 ( 54%) were community treated, and 1741 (57%) suffered from CD. Hospital-treated patients were significantly younger (49.4 ± 18.4 vs 40.4 ± 18.7,p&amp;lt;0.001 ), had higher rates of Crohn’s disease (45.9 % vs 71.4 %, p&amp;lt;0.001), exhibited higher inflammatory markers (calprotectin 768 ± 2182 vs 1305 ± 2526, p &amp;lt;0.001) , lower albumin ( 4.23 ± 0.27vs 4.12 ± 0.32, p&amp;lt;0.001)and Hemoglobin levels (13.4 ± 1.6 vs 12.9 ± 1.6, p &amp;lt;0.001) , and lower BMI (26.2 ± 5.3 vs 24.6 ± 5.6, p&amp;lt;0.001) compared to community-treated patients. Hospital-treated patients had more endoscopic procedures, higher medication utilization rates, shorter treatment durations, and increased hospitalizations occurrence (12.1 % vs 23.6 %, p&amp;lt;0.001) , length (0.67 ± 3.34 vs 1.45 ± 5.88, p&amp;lt;0.001), and colectomies (4.73 % vs 15.8 %,p&amp;lt;0.001). Table 1 displays emergency room (ER) visits, hospitalizations and colectomy among study groups,and Figure 1 displays medical treatments among study groups. Conclusion Hospital-based care is associated with more aggressive disease and intensive interventions, while community-based care may reflect milder disease and conservative management. Integrating specialized care models and personalized approaches across settings can optimize patient outcomes and healthcare delivery for IBD management.

P0814 Transmural healing in Crohn’s disease: Real-world insights from the SUNRISE study on vedolizumab using intestinal ultrasonography

Abstract Background The use of patient-centric monitoring modalities for assessing therapies, such as vedolizumab (VDZ), are of growing interest to optimize disease outcomes in patients (pts) with Crohn’s disease (CD). Transmural healing is an emerging outcome assessed by intestinal ultrasonography (IUS), which allows frequent evaluation of CD.1,2 Real-world evidence on the effectiveness of current treatments to induce and maintain transmural response to inform treatment decisions is limited. The SUNRISE study aims to describe pts with CD treated with VDZ achieving a composite outcome of complete remission, and transmural response, utilizing IUS. Methods SUNRISE is an ongoing observational, prospective study (NCT05192863) being conducted across 10 sites in Canada, Israel and Italy. Adults with moderately to severely active CD, with a bowel wall thickness of &amp;gt;3 mm based on IUS, and who newly initiated intravenous VDZ are eligible. Complete remission (defined as a composite endpoint of clinically corticosteroid-free [Harvey–Bradshaw Index score of &amp;lt;5 points and no concomitant corticosteroids], biochemical [C-reactive protein and faecal calprotectin normalization] and transmural remission [assessed by IUS]), and transmural response after VDZ treatment are reported after induction with VDZ (Weeks 10/14) and every 6 months until Month 18 or early discontinuation. Methodological details are shown in the Figure. Results This interim analysis included 70 pts; median (interquartile range [IQR]) age was 50.0 (39.0–67.0) years, time since CD diagnosis was 4.0 (0.9–17.2) years and treatment duration (n=69) was 5.0 (3.2–6.1) months. At Month 6, the proportion of pts achieving complete remission, and transmural remission and response were 3/11 (27.3%), 9/28 (32.1%) and 12/28 (42.9%) pts, respectively; data at Weeks 10/14 are shown in the Table. Median (IQR) Short Inflammatory Bowel Disease Questionnaire total score was 4.3 (3.7–5.6) at baseline, 4.5 (3.4–5.3) at Week 10, 4.7 (3.9–5.6) at Week 14 and 5.0 (4.4–6.1) at Month 6. At Month 6, 10/21 pts (47.6%) ranked IUS as their preferred test over colonoscopy, magnetic resonance elastography and computed tomography enterography. Of 40 pts with available data at Month 6, 6 (15.0%) discontinued treatment, 5 (12.5%) switched to subcutaneous VDZ and 1 (2.5%) skipped ≥1 dose of VDZ. During the observation period, 2/70 pts (2.9%) had a CD-related hospitalization, and 1/70 pt (1.4%) each had a CD-related emergency room visit or CD-related surgery (fistula removal). Conclusion The SUNRISE study provides real-world evidence for the use of VDZ to achieve transmural healing in pts with CD and supports pt preference for IUS over other monitoring modalities. Additional follow-up data are required to confirm these findings.

Impact of severe intra-abdominal adhesions on early maternal complications following cesarean delivery.

The rising rates of cesarean delivery (CD), which are a leading cause of intra-abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra-abdominal adhesions. A prospective observational study was conducted at a university-affiliated tertiary medical center (January 2021 and March 2023) in Israel. Women who underwent CD were assessed for intra-abdominal adhesions by questionnaires completed by the surgeons. Adhesions were evaluated at four anatomical sites: abdomen-to-uterus, uterus-to-bladder, skin-to-fascia, and other intra-abdominal sites. Each site was scored on a scale of 0-2, with a total score ranging from 0 to 8. Severe adhesions were defined as a total score ≥5. The primary outcome measures were a composite complication which included at least one or more of postoperative need for blood or iron products, fever, prolonged hospitalization, re-hospitalization, and emergency room visits. Overall, 2797 women were included in the study, of whom 295 (10.6%) exhibited severe adhesions. Women with severe adhesions had a higher composite risk for maternal complications following CD (RR = 1.28, 95% confidence interval [CI]: 1.12-1.45, P < 0.001), specifically, postoperative need for blood or iron products (RR = 1.71, 95% CI: 1.15-2.55, P = 0.007) and prolonged hospitalization (RR = 1.49, 95% CI: 1.10-2.03, P = 0.009). There were no significant group differences in the rates of postoperative fever, re-hospitalization or emergency room visits. In multivariate analysis, severe adhesions had an independent impact on maternal complications (CI: 1.06-1.95, P value 0.017). Severe intra-abdominal adhesions diagnosed in CD had an impact on early maternal complications.

Age, period and cohort processes in chronic obstructive pulmonary disease related emergency department visit rate in Taiwan, 2001-2015.

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits. A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model. Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women. Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

Impact of Weather and Holidays on Orthopedic Emergency Room Crowding, Fractures, and Polytraumas in a Third-Level Referral Trauma Center in Europe.

Background: Orthopedic trauma is a significant component of emergency department workloads worldwide. The relationship between weather conditions and injury rates is controversial in modern literature. Even less has been written to investigate bank holidays' influence on contusions, dislocations, fractures, and even polytrauma. Our study aimed to assess whether meteorological factors and national holidays could vary the workloads in the orthopedic ER of a European third-level trauma center. Materials and Methods: Our study consisted of a review of all the patients who underwent orthopedic evaluations in our institution's orthopedic emergency room between 2019 and 2023. Days were divided depending on weather (cloudy or sunny vs. rainy or stormy), day type (regular working days vs. national public holidays vs. Saturdays and Sundays), and presence or absence of COVID-19 restrictions. We also recorded the temperatures of each day. Cases were subdivided into three groups: cases without significant injuries (Group A), cases with isolated bone fractures, major tears or articular dislocations (Group B1), and polytrauma (Group B2). Results: Higher temperatures were associated with a significant increase in overall ER visits, isolated injuries, and polytrauma. Sunny or cloudy days had a significantly higher number of patients with all injury types compared to rainy or stormy days. Weekends saw a significant decrease in overall admissions and isolated injuries but a higher rate of polytrauma compared to weekdays. National holidays had a significantly lower number of admissions for all injury types compared to weekdays. Restrictions due to the pandemic significantly reduced overall ER visits. Conclusion: Temperatures, meteorological factors, and national holidays could vary the workloads in the orthopedic ER of a European third-level trauma center.

Prevalence and Clinical Outcomes of Eosinophilic COPD in a Saudi Population: A Retrospective Study

Abstract Objective: This study assessed the prevalence of eosinophilic chronic obstructive pulmonary disease (COPD) among a selected Saudi population and examined its correlation with baseline characteristics, clinical outcomes, exacerbation risk, and current management. Materials and Methods: This retrospective single-center study was conducted over a 2-year period. The patients were divided into two groups based on the blood eosinophil count at the time of diagnosis: eosinophilic COPD (≥300 cells/μl) and non-eosinophilic COPD (&lt;300 cells/μl) groups. Results: Overall, 156 patients were included, of which 76 (48.7%) and 80 (51.3%) patients belonged to the eosinophilic and non-eosinophilic COPD groups, respectively. There were no significant differences between both groups regarding age, gender, smoking status, coexisting morbidities, FEV1, FEV1/FVC, and COPD severity (for all, P &gt;0.05). Besides, there were no significant differences between both groups regarding the frequency and numbers of exacerbations, emergency room visits, in-patient hospitalizations, and intensive care unit admissions (for all, P &gt;0.05). Among patients with eosinophilic COPD, 64 patients (84.2%) were correctly receiving the triple therapy of long-acting β2 agonists + long-acting muscarinic antagonist + inhaled corticosteroids, whereas 4 patients (5.26%) were incorrectly receiving the dual therapy of long-acting β2 agonists + inhaled corticosteroids. Univariate regression analyses revealed that heart failure, GOLD 3 severity, use of triple therapy, and use of non-invasive ventilation were significantly correlated with a higher risk of COPD exacerbation. Conversely, higher FEV1 was significantly correlated with lower risk of COPD exacerbation. The eosinophilic COPD phenotype was not found to be a significant independent variable of COPD exacerbation. Conclusion: This study found that among Saudi patients with COPD, there was no clinically important relationship between baseline blood eosinophil count and the rate of exacerbation.

Environmental maternal exposures and the risk of premature birth and intrauterine growth restriction: The Generation Gemelli study protocol of newborn exposome.

The study of women exposures and child outcomes occurring in the first 1,000 days of life since conception enhances understanding of the relationships between environmental factors, epigenetic changes, and disease development, extending beyond childhood and spanning the entire lifespan. Generation Gemelli is a recently launched case-control study that enrolls mother-newborns pairs in one of the largest university hospitals in Italy, in order to examine the association between maternal environmental exposures and intrauterine growth restriction (IUGR) and the risk of premature birth. The study will also evaluate the association of maternal exposures and the health and growth of infants and children up to 24 months of age. The study entails the set-up of a case-control study within a birth cohort. With approximately 4,000 annual deliveries, we aim to enroll 140 cases (newborns with IUGR and premature birth) and 280 controls per year, from September 2022. A comprehensive questionnaire will be used to gather information about various types of maternal environmental exposures before and during pregnancy. We will collect biological samples from both mothers and newborns (including vaginal swab, placenta sample, blood, saliva, meconium, and bronchoalveolar lavage fluid) at birth and within the early hours of the newborn's life. We will perform laboratory examinations including dosage of heavy metals and essential elements, investigation of placental distress and fetal brain damage of biomarkers, analysis of microbiota and of DNA methylation profile. We will conduct clinical follow-up assessments in both cases and controls at months 12 and 24 and we will collect anthropometric data, feeding types with particular reference to breastfeeding and its duration, pediatric emergency room visits, hospitalizations, medication usage, known allergies, and neuropsychological development. The Generation Gemelli case-control study holds the promise of significantly enhancing our comprehension of how maternal environmental exposures relate to the health of children and the broader population. The study of the exposome will provide insights into the relationships between environmental exposures, epigenetic changes and health outcomes during the first 1000 days of life and onward.

Infant mental health integration into OB care leads to increased connection to services during the perinatal period.

We compared referrals and connection to care between perinatal patients: 90 receiving OB/GYN care in clinics with integrated behavioral health consultants with infant mental health specialization (IMH-BHC), and 68 receiving traditional care, in the United States. Participants identified as: Native American/Alaskan native, 1.90%; Asian,.63%; African American, 58.23%; Middle Eastern, 6.96%; African National/Caribbean Islander,.63%; Latin-American, 8.86%; and White, 28.48%. Approximately 80% of families in each group were offered referrals. By design, intervention women received mental health services during pregnancy; 16% of women in either group received postpartum mental health services. Intervention group participants were over three times as likely to engage in IMH home visiting. Treatment families were less likely to follow up with infant referrals, but also had fewer infant emergency room visits. All intervention participants met with an IMH-BHC prior to recruitment; however, only 20% self-reported encounters with a mental health professional, indicating these interactions may not be identified by the participants as mental health care; therefore, openness to treatment may be increased for women who feel stigma around mental health care. Given the importance of perinatal mental health, OB/GYN clinics and others serving perinatal patients may consider integrating IMH providers as part of the care team.