Background/Purpose:
There is sparse data examining the characteristics of SLE patients who frequent
the emergency room (ER). Data suggest that lupus patients with certain sociodemographic
risk factors and possibly lack of access to preventive care are more likely to
go to the ER. We sought to explore which characteristics were associated with
ER utilization in our lupus cohort.

Methods: 125 patients
fulfilling the ACR criteria for SLE were recruited during routine ambulatory
visits between November 2013 and December 2014. Demographics, disease duration,
preventive care, healthcare utilization, reason for ER visit, who referred the patient
to the ER, disposition, and prevention of ER visits were elicited via a patient
reported questionnaire. Patients also completed the Medication Adherence Self-Report
Inventory (MASRI), Visual Analog Scale (VAS) for pain, Short Form 36 Health
Survey (SF-36), Beck depression Inventory, and Interpersonal Support Evaluation
List (ISEL).  We compared patients with no ER visits versus ≥ 1 ER visit
in the past year. Categorical variables were evaluated using chi-square while
continuous variables were evaluated using two-tailed Student’s unpaired t-test,
Wilcoxon rank-sum test, or logistic regression analysis. 

Results: Patients with
≥ 1 ER visit were more likely to be younger, non-Caucasian, single, non-college
graduates, and have Medicaid.  ER utilizers also had higher pain scores, worse
overall mental and physical health, and increased depression. Patients who
utilized the ER were also less likely to have ever had a lipid panel (Table 1).
There was no difference in frequency of PCP or rheumatology appointments, mammograms,
flu shots, pap smears.  In a multivariate analysis, only younger age was found
to be associated with ≥ 1 ER visit.

In regards to characteristics associated with each ER
visit, 57.3% of patients went to the ER due to lupus. 73% of patients self-directed
themselves to the ER and felt nothing could have prevented the ER visit. Only 23.4%
of these ER visits actually resulted in admission. The majority of ER visits
were reportedly due to pain/arthritis (26.5%) and cardiopulmonary complaints
(20.5%).

Conclusion: Frequent
ER utilization was shown to be associated with certain sociodemographic
features and worse self-reported outcomes. Studies from the general population
have also found an association with frequent ER use and poor access to medical
care. Conversely, our data showed that access to primary care, rheumatology,
and preventive services was equivalent between the two groups. This suggests
that access to care may not be associated with ER utilization in the SLE
population.  Lastly, given the majority of patients self-directed
themselves to the ER and were not admitted to the hospital, we need to educate
them to call their physician first to determine the utility of an ER evaluation.

Table 1

Characteristics of study population by ER Visits