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Prior emergency department visits predict future emergency department use in pediatric inflammatory bowel disease
Hannah H Resnick1,2, Christopher J Moran1,2
1Department of Pediatrics, MassGeneral for Children, Boston, Massachusetts, USA.
Insights
Previous emergency department (ED) visits in children with inflammatory bowel disease (IBD) increase the risk of future ED use. The initial months post-diagnosis are a critical period for ED utilization in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Healthcare Management
- Public Health
Background:
- Emergency department (ED) visits for pediatric inflammatory bowel disease (IBD) incur significant healthcare costs.
- A substantial proportion of these ED visits are potentially preventable, highlighting a need for better management strategies.
Purpose of the Study:
- To identify factors associated with emergency department (ED) utilization in pediatric patients diagnosed with inflammatory bowel disease (IBD).
- To understand the temporal risk of ED use following IBD diagnosis in children.
Main Methods:
- Retrospective analysis of electronic medical records for pediatric IBD patients (0-21 years) at a tertiary care center.
- Evaluation of demographics, disease characteristics, and laboratory results to predict ED visits within six months.
- Multivariable logistic regression and Kaplan-Meier analysis to determine risk factors and temporal trends of ED use.
Main Results:
- Previous ED visits (all-cause and IBD-related) were significant predictors of future ED use in pediatric IBD patients.
- Public insurance and recent IBD diagnosis (within 6 months) were associated with all-cause ED visits.
- The highest rate of IBD-related ED use occurred within the first month after diagnosis, stabilizing over the subsequent year.
Conclusions:
- Past emergency department (ED) utilization is a key risk factor for subsequent ED visits in pediatric inflammatory bowel disease (IBD) patients.
- The period immediately following diagnosis represents a high-risk window for ED utilization, necessitating targeted interventions.
Objectives:
Emergency department (ED) visits represent a significant cost in the care of children with inflammatory bowel disease (IBD). Many of these visits are potentially preventable. We aimed to evaluate factors associated with ED use in pediatric patients with IBD.
Methods:
Patients with IBD aged 0-21 years at a single tertiary center were identified via electronic medical record query. Demographics, disease characteristics, and recent laboratory results were extracted. ED visits in the 6 months following data extraction were tallied. Multivariable logistic regression was performed to evaluate risk factors for ED use. Kaplan-Meier curve analysis was used to understand the risk of IBD-related ED use over time following initial diagnosis.
Results:
Of the 531 patients identified, 49 (9%) visited the ED during the study period and 22 (4.1%) had an IBD-related visit. Number of recent ED visits (odds ratio [OR] 3.168, 95% confidence interval [CI] 1.925-5.466), public insurance (OR 2.232, 95% CI 1.021-4.665), and IBD diagnosis within the last 6 months (OR 2.964, 95% CI 1.039-7.918) were risk factors for all-cause ED use, though only number of recent ED visits (OR 2.105, 95% CI 1.110-3.668) was associated with IBD-related ED use. For the 391 patients included in the analysis of IBD-related ED use over time, the rate of ED use was highest the first month after diagnosis (slope 0.268, 95% CI 0.258-0.279) and plateaued over the following year.
Conclusions:
Recent ED use, regardless of cause, is an important risk factor for IBD-related ED use in pediatric patients. The first several months after diagnosis constitute a particularly high-risk time for ED use.
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