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. 2015 Jul;60(7):2183-9.
doi: 10.1007/s10620-015-3594-z. Epub 2015 Feb 28.

High Rate of Hospital Admissions Among Patients with Cirrhosis Seeking Care in US Emergency Departments

Chanda K Ho  1 , Judith H Maselli, Norah A Terrault, Ralph Gonzales
Affiliations

High Rate of Hospital Admissions Among Patients with Cirrhosis Seeking Care in US Emergency Departments

Chanda K Ho et al. Dig Dis Sci. 2015 Jul.

Abstract

Background and aims: Emergency Departments (ED) can serve as a gateway to specialty care for patients with cirrhosis with limited care access. We described the rates and characteristics of patients with cirrhosis who access United States (US) EDs, and identified factors associated with subsequent hospitalization.

Methods: Using data from the National Hospital Ambulatory Medical Care Survey, cirrhosis-related ED from 2000 to 2009 were identified and compared to all other ED visits.

Results: From 2000 to 2009, there were an estimated 1,029,693 cirrhosis and 877 million non-cirrhosis visits. Compared to the general ED population, those with cirrhosis were more frequently male (58 vs. 44 %, p = 0.02), Hispanic (18.6 vs. 10.6 %, p < 0.05), seeking care in urban areas (91.6 vs. 73.4 %, p < 0.05) and had Medicaid/no insurance (43 vs. 35 %, p < 0.01). Patients with cirrhosis were more frequently triaged immediately or emergently (72.3 vs. 54.2 %, p < 0.01). The majority were admitted or transferred to another hospital (66.8 vs. 17.4 %, p < 0.01). Among patients with cirrhosis, patients with age ≥ 65 years were more likely to be admitted (adjusted OR 2.49, 95 % CI 1.08-5.73), and Medicaid/uninsured (adjusted OR 0.34; 95 % CI 0.17-0.67) were less likely to be admitted, after adjusting for patient demographics, hospital characteristics, and triage score.

Conclusions: Patient with cirrhosis account for approximately 100,000 US ED visits annually. The higher admission rates among patients with cirrhosis indicate a high acuity of illness. Older age among those admitted may reflect poorer functional status. Finally, high visit but low admission rates among those with Medicaid/no insurance suggest a gap in specialty care.

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Conflict of interest statement

Conflict of interest None.

Figures

Fig. 1
Fig. 1
Number of cirrhosis and all other ED visits: 2000–2009. The ED visits are shown in the line graph with the axis on the left. The cirrhosis visits are shown in the bar graph with the axis on the right
Fig. 2
Fig. 2
Geographic distribution of cirrhosis visits versus all other ED visits
See this image and copyright information in PMC

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