Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA
Inflammatory bowel disease (IBD) is a chronic, debilitating condition with high emergency department (ED) utilization. We aimed to investigate the utilization patterns of ED by IBD patients and measure hospitalization and surgical rates following ED visits.
We conducted a cross-sectional study of adults with IBD listed as the primary ED diagnosis from the 2009 to 2011 Nationwide Emergency Department Sample. The characteristics of the IBD-related ED visits in relation to following hospitalizations and surgeries were analyzed.
Adult IBD patients constitute 0.09 % of the total ED visits. Crohn’s disease (CD) contributed to 69 % of the IBD-ED visits. The hospitalization rate from ED was 59.9 % nationally, ranging from 56 % in west to 69 % in northeast. The most significant factors associated with hospitalization were intra-abdominal abscess [odds ratio (OR) 24.22], bowel obstruction (OR 17.77), anemia (OR 7.54), malnutrition (OR 6.29), hypovolemia/electrolyte abnormalities (OR 5.57), and fever/abnormal white cell count (OR 3.18). Patients with CD (OR 0.66), low-income group (OR 0.90), and female gender (OR 0.87) have a lower odds of getting hospitalized. Age above 65 years (OR 1.63), CD (OR 1.89), bowel obstruction (OR 9.24), and intra-abdominal abscess (OR 18.41) were significantly associated with surgical intervention.
The IBD-related ED visits have remained relatively stable from 2009 to 2011. The presence of anemia, malnutrition, hypovolemia, electrolyte abnormalities, fever, abnormal white cell count, bowel obstruction, or intra-abdominal abscess during the ED visit was associated with hospitalization. The presence of bowel obstruction and intra-abdominal abscess was strongly associated with surgical intervention.
KeywordsCrohn’s disease Ulcerative colitis Emergency department Hospitalization Regional variations
Inflammatory bowel disease
Ioannis E. Koutroubakis was supported by a sabbatical salary of Medical Faculty University of Crete Greece. David G. Binion was supported by a Grant W81XWH-11-2-0133 from the US Army Medical Research and Materiel Command.
Guarantor of the article
David G. Binion.
Mahesh Gajendran contributed to study concept and design, acquisition of data, statistical analysis and interpretation of data, and drafting of the manuscript. Chandraprakash Umapathy contributed to study concept and design, statistical analysis and interpretation of data, figures, and drafting of the manuscript. Priyadarshini Loganathan contributed to study concept and design, statistical analysis and interpretation of data, and drafting of the manuscript. Jana G. Hashash, Ioannis E. Koutroubakis, and David G. Binion critically revised the manuscript for important intellectual content.
Compliance with ethical standards
Conflict of interest
- 16.Merrill C, Owens PL. Hospital Admissions That Began in the Emergency Department for Children and Adolescents, 2004: Statistical Brief #32. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD); 2006.Google Scholar
- 20.NEDS Overview. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nedsoverview.jsp; 2014.
- 24.Centers for Disease Control and Prevention. FastStats—Emergency Department Visits; 2015.Google Scholar