title: Frequent attenders to the ED: patients who present with repeated asthma exacerbations.
abstract: BACKGROUND
  Asthma has been reported as one of the main causes of frequent attendance to the emergency department (ED), and many of those visits are potentially preventable. Understanding the characteristics of frequent attender (FA) patients with asthmatic exacerbations will help to identify factors associated with frequent attendance and improve case management. The aim of this study is to describe the characteristics of FA who present multiple times to the ED for asthma exacerbations.
  
  
  METHODS
  This study was a retrospective review of cases presented to Singapore General Hospital ED in 2010. Patients who attended the ED for 4 times or more with at least 1 visit attributable to asthma exacerbations in 2010 were included. They were then categorized as FA with multiple exacerbations (FAME) and those with fewer exacerbations.
  
  
  RESULTS
  Of 105616 ED patients, 155 patients attending the ED in 2010 were identified as FA with asthma, and 26 (17%) of these patients were classified as FAME, resulting in 213 visits (45% of total visits). Compared with FA with fewer exacerbations group, FAME were more likely to be men (P = .002), unemployed (P < .000), bad debtors (P = .045), substance abusers (P = .022), previously known to medical social workers (P = .002), and were found to spend a longer amount of time in the ED (>6 hours) (P = .03).
  
  
  CONCLUSIONS
  We found that a small number of FAME patients accumulated a large number of ED visits and spent a significantly longer time in the ED. This group tended to be males with social, financial, and addiction problems.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Shu Fen
authors.initials: SF
authors.lastname: Lim
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Win
authors.initials: W
authors.lastname: Wah
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Yogeswary
authors.initials: Y
authors.lastname: Pasupathi
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Susan
authors.initials: S
authors.lastname: Yap
authors.affiliation: Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore.
authors.forename: Mariko Siyue
authors.initials: MS
authors.lastname: Koh
authors.affiliation: Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore.
authors.forename: Keng Leong
authors.initials: KL
authors.lastname: Tan
authors.affiliation: Operations and Performance Management, Singapore General Hospital, Singapore.
authors.forename: Cass Jwee Cheong
authors.initials: CJ
authors.lastname: Chay
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore. Electronic address: marcus.ong.e.h@sgh.com.sg.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D012959:Socioeconomic Factors