[Spontaneous visits to the emergency service and hepatology day hospital by patients with liver cirrhosis].
BACKGROUND
Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC.


METHODS
We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected.


RESULTS
There were 743 consultations, of which 62% involved the HDH. The mean age was 65±12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p<0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p<0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p<0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p<0.01); radiology: 71% ES versus 11% HDH (p<0.01) and paracentesis: 51% ES versus 74% HDH (p<0.01). The mean length of stay in the ES was 21.3±121.5 hours compared with 3.3±2.4 hours in the HDH (p<0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p<0.05).


CONCLUSIONS
Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient.
Servicio de Aparato Digestivo, Hospital de Sabadell, Barcelona, España. martagm81@hotmail.com
Marta
M
Gallach
Judit
J
Pérez
Mercedes
M
Vergara
Gemma
G
Olivé
Mireia
M
Miquel
Meritxell
M
Casas
Montserrat
M
Gil
Blai
B
Dalmau
Jordi
J
Sánchez
Angelina
A
Dosal
Laura
L
Moreno
Eulàlia
E
Alavedra
Emili
E
Gené
D000368:Aged; D003631:Day Care, Medical / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology; D006782:Hospitals, Special; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy; D008297:Male; D011446:Prospective Studies