Trends in emergency department visits and hospitalization rates for inflammatory bowel disease in the era of biologics

Abstract

BackgroundThe use of biologics in inflammatory bowel disease (IBD) has increased recently. However, studies on whether the proportion of IBD patient visits to the emergency department (ED) has decreased are scarce. We investigated the trends in IBD-related ED visits and hospitalization rates.MethodsMedical records of IBD-related visits to the ambulatory department (AD) and the ED of the Seoul National University Bundang Hospital in 2007, 2009, 2012, and 2014 were reviewed. Multiple-variable logistic regression analysis was used to identify significant risk factors for hospitalization.ResultsThe proportion of IBD patients who visited ED was 12.3% in 2007, 9.7% in 2009, 8.3% in 2012, and 6.4% in 2014 (P = 0.002). The most common chief complaints were abdominal pain (66.9%) in Crohn’s disease (CD) patients and hematochezia (36.5%) in ulcerative colitis (UC) patients. The hospitalization rate following ED visits was 47.2% in CD patients and 55.6% in UC patients (P = 0.100). Multiple-variable analysis showed that significant risk factors associated with hospitalization in CD were aggressive disease behavior (odds ratio[OR] 3.54, P = 0.017) and presence of steroid exposure (OR 2.35, P = 0.047). Elevated C-reactive protein (CRP) (>0.5 mg/dL) (OR 5.40, P = 0.016) was the only risk factor associated with hospitalization in UC.ConclusionsThe proportion of ED visits decreased from 2007 to 2014; there was no significant change in hospitalization rates. Disease behavior/presence of steroid exposure and elevated CRP were associated with hospitalization among CD and UC patients who visited the ED, respectively.

Biologic therapy is associated with a mild decrease in the rate of hospitalizations in pediatric IBD

“…The impact of the introduction of biologic therapy on disease-related hospitalizations has been investigated in previous studies with inconsistent results. Comparable to the current study that showed a similar hospitalization rate before and after biologic therapy, several studies, mainly in the adult population, reported no change in the rates of IBD-related hospitalizations [ 20 , 38 ]. Other studies observed an increase in hospitalizations in the last two decades and an increased risk of hospitalization in patients treated with thiopurines, corticosteroids, and anti-TNF-α agents [ 22 , 39 ].…”

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

“…In the last two decades, the rates of IBD related admissions and IBD related surgeries declined significantly. Surprisingly, the number of IBD-related ED visits has numerically surged, but the proportion of IBD patients who needed ED care decreased [ 10 , 13 ]. This is an interesting phenomenon explained in part by the rise in IBD cases in some parts of the world and by the existence of a group of patients who tend to have recurrent visits to the ED.…”

“…Furthermore, studies have shown that while young female patients tend to visit the ED more often [ 15 ], older and male patients are more likely to be admitted [ 12 , 13 ]. Smokers, highest income quartile patients, penetrative disease, and steroid exposure are also predictors of hospitalization [ 10 , 13 ].…”

“…Nevertheless, many patients with CD experience exacerbations and complications of the disease. According to the literature, at least 11.3% of patients with inflammatory bowel diseases (IBD) seek acute care in the emergency department every year, with at least half of them hospitalized [ 10 , 11 ].…”

“…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 ].…”