小児炎症性腸疾患における過去の救急科受診歴が将来の救急科利用を予測する

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.

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.

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.

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.