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Abstract Number: 1260

Predictors of Hospitalization Due to Acute Gout: A Retrospective Cohort Study

Nadine Mbuyi1, Isha Shah2, Steven Reinert3, Grayson Baird4, Pieusha Malhotra5, Ross Hilliard6 and Deepan Dalal7, 1Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, 2Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 3Lifespan Information Services, Lifespan Information Services, Providence, RI, Providence, RI, 4Department of Biostatistics, Lifespan, Rhode Island Hospital, Providence, RI, 5Rheumatology, Roger William Medical Center, Providence, RI, Providence, RI, 6Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 7Medicine/Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Co-morbidities, Crystal-induced arthritis, gout, quality improvement and quality of care

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Session Information

Date: Monday, October 22, 2018

Title: Measures and Measurement of Healthcare Quality Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Despite effective treatments, hospitalization due to acute gout is increasing and is financially burdensome. Prior studies have primarily attributed the increased rate of gout hospitalizations to physicians’ gaps in knowledge regarding gout management. However, these studies fail to address patient and systems factors which may be associated with this risk. Our aim was to assess the association between these factors and risk of hospitalization among patients visiting the emergency department (ED) using a statewide healthcare system.

Methods: Lifespan is the largest provider of healthcare in Rhode Island and has 3 EDs across the state. We identified gout patients 18 years of age or older who presented to the ED between 3/30/2015 and 9/30/2017 using ICD9 and ICD10 diagnostic codes. If the patient was seen more than once during this time only the first encounter was included. Outcome of interest was admission from ED to inpatient or observation. We collected information regarding: a) patients factors including demographics, medications and comorbidities assessed at presentation, b) clinical presentation of gout (single versus multiple joint involvement) and severity as assessed by the triage nurse on a 5-point ED severity scale (1 being the worst), and c) systems factors including time of day and time of year at presentation to the ED, and type of insurance (commercial versus state health agencies/governmental insurance). A multivariable logistic regression model was used to identify factors associated with hospitalization.

Results: A total of 458 patients (mean age 58.71 ± 16.36 years, 79.43% males) were included. Of these 458 patients, 51 patients (11.1%) were admitted; 29 (6.4%) to inpatient and 22 (4.8%) to observation. Older age, presence of comorbidities, pattern of joint involvement and severity and time of presentation to the ED were associated with increased odds of admission. In a multivariable model, older age [aOR 1.05 (1.01 to 1.08)], having oligo- or polyarticular gout [aOR 8.67 (3.50 to 21.48)], diabetes [aOR 4.74 (1.86 to 12.11)], history of inflammatory arthritis [aOR 5.83 (1.36 to 25.01)] and time of presentation to the ED between 8 AM–4 PM [aOR 5.92 (1.28 to 27.46)] and 4 PM–12 AM [aOR 7.04 (1.35 to 36.66)] continued to remain significant.

Conclusion: Our study demonstrates increased hospitalization rates among older patients, and those with comorbid diabetes or pre-existing inflammatory arthritis. This may be related to fear that these patients are at higher risk of joint infection. The study highlights increased odds of admission in patients presenting between 8 AM and midnight compared to those presenting between midnight and 8AM. It is likely that decision to admit in case of the latter is made during regular business hours. Hence, highlighting the need to improve systems for after hour care of gout patients.

Table 1: Baseline cohort characteristics

 

Discharged from the ED (n=)

Admitted from the ED (n=)

 Age (mean ± SD) *

57.2 ± 16.02

70.8 ± 13.87

 

Gender

Male

328/406 (80.8%)

35/51 (68.6%)

 

Ethnicity

African American

72/406 (17.7%)

5/51 (9.8%)

Asian

10/406 (2.5%)

3/51 (5.9%)

Caucasian

249/406 (61.3%)

38/51 (74.5%)

Other

75/406 (18.5%)

5/51 (9.8%)

 

Pattern of joint involvement*

Oligo/polyarticular

50/407 (12.3%)

21/51 (41.2%)

 

Comorbidities

 

Diabetes*

97/304 (31.9%)

33/50 (66%)

Hyperlipidemia*

185/304 (60.9%)

41/50 (82%)

Prior gout history

214/304 (70.4%)

30/50 (60%)

Alcohol use

39/304 (12.8%)

6/50 (12%)

Chronic pain

8/304 (2.6%)

0/50 (0%)

Hypertension*

227/304 (74.7%)

49/50 (98%)

Coronary artery disease

70/304 (23%)

26/50 (52%)

Heart failure*

58/304 (19.1%)

20/50 (40%)

Chronic kidney disease*

65/304 (21.4%)

23/50 (46%)

Inflammatory arthritis*

13/304 (4.3%)

7/50 (14%)

 

ED Severity Index*

2/3 (moderate severity)

184/355 (51.9%)

41/48 (85.4%)

4/5 (least severe)

171/355 (48.1%)

7/48 (14.6%)

 

Time of day patients presented to the ED*

12 AM – 8 AM

72/355 (20.3%)

3/49 (6.1%)

8 AM – 4PM

175/355 (49.3%)

29/49 (59.2%)

4 PM – 12 AM

108/355 (30.4%)

17/49 (34.7%)

 

Time of the year patients presented to the ED

Jan – March

64/355 (18%)

10/49 (20.4%)

April – June

122/355 (34.4%)

10/49 (20.4%)

July – Sept

97/355 (27.3%)

16/49 (32.7%)

Oct – Dec

72/355 (20.3%)

13/49 (26.5%)

 

Insurance carrier*

 

Medicare, Medicaid or other State Health

191/406 (47%)

38/51 (74.5%)

Commercial

173/406 (42.6%)

13/51 (25.5%)

Self-pay or Uninsured

42/406 (10.3%)

0/51 (0%)

*  Represents statistically significant results (p <0.05)


Disclosure: N. Mbuyi, None; I. Shah, None; S. Reinert, None; G. Baird, None; P. Malhotra, None; R. Hilliard, None; D. Dalal, None.

To cite this abstract in AMA style:

Mbuyi N, Shah I, Reinert S, Baird G, Malhotra P, Hilliard R, Dalal D. Predictors of Hospitalization Due to Acute Gout: A Retrospective Cohort Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/predictors-of-hospitalization-due-to-acute-gout-a-retrospective-cohort-study/. Accessed .
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