Julia McNabb-Baltar1, Shadeah L Suleiman2, Peter A Banks2, Darwin L Conwell3. 1. Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. jmcnabb-baltar@bwh.harvard.edu. 2. Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. 3. Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, 410 W 10th Ave Fl 2, Columbus, OH, 43210, USA.
Abstract
OBJECTIVES: Chronic pancreatitis (CP) is a debilitating chronic illness. We sought to assess the most common reasons patients with CP visit the Emergency Department (ED), the disposition of ED visit [admission, discharge, death], and evaluate predictors of admission and discharge. METHODS: Within the Health Care Utilization Project Nationwide Emergency Department Sample (NEDS), we focused on patients, 18 years and older, presenting to the emergency department with CP (ICD-9 code 577.1) (2006-2009). Model was fitted to predict the likelihood of admission. RESULTS: Overall, a weighted sample of 638,310 patients visits for CP were identified, of which 399,559 (62.6%) were admitted, 228,523 (35.8%) were discharged from the ED, 5572 (0.9%) discharged against medical advice, and 4656 (0.7%) had an unknown destination. Of those admitted, 4370 (0.7%) died during the hospital episode. The most associated diagnoses for ED visit were diabetes (28.8%), abdominal pain (25.4%), acute pancreatitis (22.5%), cardiac complication (11.1%), infection (10.1%), and dehydration (8.8%). Multivariable analyses revealed that older (OR = 1.02 P < 0.001), sicker patients (Charlson Comorbidity Index ≥ 3, OR = 2.28 P < 0.001), patients presenting with C. difficile colitis (OR = 23.85 P < 0.001), alcohol withdrawal (OR = 6.71 P < 0.001), and acute pancreatitis (OR = 6.46 P < 0.001) were associated with increased odds of hospitalization. CONCLUSIONS: In this national database, our study demonstrates that diabetes, followed by abdominal pain, acute pancreatitis and cardiac complication, were the most common diagnoses associated with ED visits in patients with chronic pancreatitis. Most patients were admitted following the ED visit. Although C. Difficile colitis was a rare associated diagnosis with an ED visit, it was the strongest predictor of admission.
OBJECTIVES:Chronic pancreatitis (CP) is a debilitating chronic illness. We sought to assess the most common reasons patients with CP visit the Emergency Department (ED), the disposition of ED visit [admission, discharge, death], and evaluate predictors of admission and discharge. METHODS: Within the Health Care Utilization Project Nationwide Emergency Department Sample (NEDS), we focused on patients, 18 years and older, presenting to the emergency department with CP (ICD-9 code 577.1) (2006-2009). Model was fitted to predict the likelihood of admission. RESULTS: Overall, a weighted sample of 638,310 patients visits for CP were identified, of which 399,559 (62.6%) were admitted, 228,523 (35.8%) were discharged from the ED, 5572 (0.9%) discharged against medical advice, and 4656 (0.7%) had an unknown destination. Of those admitted, 4370 (0.7%) died during the hospital episode. The most associated diagnoses for ED visit were diabetes (28.8%), abdominal pain (25.4%), acute pancreatitis (22.5%), cardiac complication (11.1%), infection (10.1%), and dehydration (8.8%). Multivariable analyses revealed that older (OR = 1.02 P < 0.001), sicker patients (Charlson Comorbidity Index ≥ 3, OR = 2.28 P < 0.001), patients presenting with C. difficilecolitis (OR = 23.85 P < 0.001), alcohol withdrawal (OR = 6.71 P < 0.001), and acute pancreatitis (OR = 6.46 P < 0.001) were associated with increased odds of hospitalization. CONCLUSIONS: In this national database, our study demonstrates that diabetes, followed by abdominal pain, acute pancreatitis and cardiac complication, were the most common diagnoses associated with ED visits in patients with chronic pancreatitis. Most patients were admitted following the ED visit. Although C. Difficilecolitis was a rare associated diagnosis with an ED visit, it was the strongest predictor of admission.
Authors: R Pezzilli; A M Morselli-Labate; L Frulloni; G M Cavestro; B Ferri; G Comparato; L Gullo; R Corinaldesi Journal: Dig Liver Dis Date: 2005-10-19 Impact factor: 4.088
Authors: Dhiraj Yadav; Robert H Hawes; Randall E Brand; Michelle A Anderson; Mary E Money; Peter A Banks; Michele D Bishop; John Baillie; Stuart Sherman; James DiSario; Frank R Burton; Timothy B Gardner; Stephen T Amann; Andres Gelrud; Christopher Lawrence; Beth Elinoff; Julia B Greer; Michael O'Connell; M Michael Barmada; Adam Slivka; David C Whitcomb Journal: Arch Intern Med Date: 2009-06-08
Authors: Dhiraj Yadav; Lawrence Timmons; Joanne T Benson; Ross A Dierkhising; Suresh T Chari Journal: Am J Gastroenterol Date: 2011-09-27 Impact factor: 10.864
Authors: Gregory A Coté; Dhiraj Yadav; Adam Slivka; Robert H Hawes; Michelle A Anderson; Frank R Burton; Randall E Brand; Peter A Banks; Michele D Lewis; James A Disario; Timothy B Gardner; Andres Gelrud; Stephen T Amann; John Baillie; Mary E Money; Michael O'Connell; David C Whitcomb; Stuart Sherman Journal: Clin Gastroenterol Hepatol Date: 2010-10-26 Impact factor: 11.382
Authors: A B Lowenfels; P Maisonneuve; G Cavallini; R W Ammann; P G Lankisch; J R Andersen; E P DiMagno; A Andrén-Sandberg; L Domellöf; V Di Francesco Journal: Am J Gastroenterol Date: 1994-09 Impact factor: 10.864