2016/10/01 by Lauren N. Stemboroski, Lauren Stemboroski, Ciel Harris +1
Medicine · #Emergency and Acute Care Studies
paper · doi:10.14309/00000434-201610001-01026
Introduction: Gastrointestinal (GI) hemorrhage is a common complaint encountered in the emergency department (ED) resulting in over 600,000 ED visits per year. Re-bleeding episodes are not uncommon and pose an economic burden on the healthcare system. The aim of this study is to define the rate of ED visits, hospitalization and early readmission for GI hemorrhage using a national database. Methods: The Nationwide Emergency Department Sample (NEDS) and Nationwide Inpatient Sample (NIS) database was used to determine ED admission and 30-day readmission rate in 2012-2013. Patients with Index stay 153 in Clinical Classification Software for GI hemorrhage were examined. Early readmission is defined as an index stay with at least one readmission within 30 days of discharge.Table 1: Early readmissions with GI Hemorrhage in any diagnosisResults: There were 1,325,143 ED visits due to GI hemorrhage in 2012-2013, which included 628,447 admissions for acute hospitalization. The majority of the presenting patients were in the 65-84 year old age group while the highest numbers of patients admitted were aged 85 and older. Elderly patients had the highest LOS. The rate of admission was similar between males and females. The total number of inpatients with principal diagnosis of GI hemorrhage in years 2012-2013 was 649,481. Of these, 20,109 patients (3.1%) patients were readmitted with GI hemorrhage as their primary diagnosis, within 30 days. Patients 18-44 years old had the highest readmission rate with GI hemorrhage while the elderly were more likely to be readmitted with hemorrhage as a secondary diagnosis. The mean cost of readmission was higher than initial hospitalization (9,590 vs 11,329). Out of the 649,481 individuals with GIH, 109,342 (16.9%) were readmitted for any cause in following 30 days. Conclusion: Elderly patients make up the majority of patients who present to the ED with GI hemorrhage and are more likely to be hospitalized than other age groups. Among patients with GI hemorrhage, the 30-day readmission rate for any cause exceeded readmissions associated with GI hemorrhage across all age groups. Comorbidities are likely contributing to the observed admission rate, mortality and readmission rates among older patients. Elderly patients have a longer length of stay with the most discharges to another institution (ie. nursing home, rehab). Younger age was associated with a higher rate of readmission for the same CCS as principal diagnosis; this is likely affected by the lower rate of admission from the ED.