title: Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gajendran
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Chandraprakash
authors.initials: C
authors.lastname: Umapathy
authors.affiliation: Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
authors.forename: Priyadarshini
authors.initials: P
authors.lastname: Loganathan
authors.affiliation: Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.affiliation: Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.|Department of Gastroenterology, University Hospital Heraklion, Crete, Greece.
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.affiliation: Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA. binion@pitt.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000453:epidemiology*; D007415:Intestinal Obstruction / Q000150:complications / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011203:Poverty; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
keywords: Crohn’s disease; Emergency department; Hospitalization; Regional variations; Ulcerative colitis