Prediction of Recurrent Emergency Department Visits among Patients with Crohn’s Disease: A Retrospective Study

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.

Risk factors for recurrent emergency care utilization for flares in inflammatory bowel disease

“…None of these studies specifically examined recurrent short‐term ED utilization after an initial ED encounter 11 . A tertiary care study from Israel did find that abnormal clinical markers, including laboratory values and vital signs, were associated with increased risk of recurrent ED use among patients with CD 12 . There is limited understanding of how additional sociodemographic and clinical characteristics, and specifically, occurrence of post‐ED follow care, might be associated with recurrent ED utilization among patients with IBD.…”

Comprehensive Management of Inflammatory Bowel Disease: What’s Next

“…This can take a toll on patient well-being and healthcare in terms of delayed diagnosis of complications and economic cost, respectively. Mahajna et al [ 6 ] demonstrated a 60% hospitalization rate of all patients with CD-related complaints presenting to the emergency department (ED) and a considerable 17.4% 30-day re-visit rate of those who were discharged. Notably, the factors associated with returning to the ED were tachycardia and anemia.…”