Background: The use of biologics in inflammatory bowel disease (IBD) has increased recently. However, studies on whether the proportion of emergency department (ED) visits has decreased are scarce. The aim of this study was to investigate the trends in IBD-related ED visits and hospitalization rates.
Methods: Medical records of IBD-related visits in ambulatory department and ED at Seoul National University Bundang Hospital in 2004, 2009 and 2014 were reviewed. Demographics and clinical characteristics were compared among IBD patients who visited ED. Multiple-variable regression analysis was used to identify possible covariates as significant risk factors for hospitalization in IBD patients who visited ED.
Results: The proportion of IBD patients who visited ED was 6.67% in 2004, 9.44% in 2009 and 6.24% in 2014. The proportions were not significantly different in these three years (p=0.138). The mean age of them was 34.5±14.0 years and 70.8% of them were men. Median duration of disease was 44.2 months (interquartile range [IQR] 11.5 to 73.3). The most common chief complaints were abdominal pain (67.6%) in Crohn's disease (CD) patients and hematochezia (39.4%) in ulcerative colitis (UC) patients. The hospitalization rate from ED was 48.5% in CD patients and 50% in UC patients. Median duration of hospitalization was 14.2 days (IQR 4.3 to 16.5). Multiple-variable regression analysis showed that significant risk factors associated with hospitalization were disease duration less than 6 years (RR=3.116, p=0.028), leukocytosis (WBC >10.0×103) (RR=2.608, p=0.031) and elevated C-reactive protein (CRP >1.0 mg/dL) (RR=2.751, p=0.021). Time interval between the last ambulatory department and the ED visit was not associated with hospitalization.
Conclusions: The absolute number of IBD-related ED visits increased from 2004 to 2014; but there was no significant change in proportion of ED visits and hospitalization rates during these time period. Disease duration less than 6 years, leukocytosis, elevated CRP were associated with hospitalization among IBD patients who visited ED.