Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments
Objectives. Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding, resulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent attenders of EDs examine general patients without clas...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2020/8289275 |
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| author | Chen-Ju Chuang Yi-Fang Wu Kai-Hsiang Wu Yi-Chuan Chen |
| author_facet | Chen-Ju Chuang Yi-Fang Wu Kai-Hsiang Wu Yi-Chuan Chen |
| author_sort | Chen-Ju Chuang |
| collection | DOAJ |
| description | Objectives. Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding, resulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent attenders of EDs examine general patients without classifying certain subgroups. This study aimed to investigate patients with liver cirrhosis who present repeatedly to the ED. Methods. This was a retrospective, observational cohort study of adult patients with a history of liver cirrhosis presenting to the ED from January 2011 to December 2015. We included patients with cirrhosis whose first ED visit occurred during the study period. We went far back for 20 years and excluded patients with any ED visits (including both cirrhosis and noncirrhosis-related ones) before the study period. We categorized frequent attenders as patients with more than 4 ED visits within 12 months after the first ED visit; infrequent attenders were those who did not meet this criterion. Results. A total of 3513 patients with cirrhosis were included in this retrospective cohort study. Compared with the infrequent attenders, frequent attenders had a higher rate of presentations due to hepatic encephalopathy (15.2% vs 13.7%, P<0.001) and ascites (10% vs 4%, P<0.001). A Kaplan–Meir survival analysis revealed that frequent attendance was not associated with increased mortality during the study period (hazard ratio 1.02, 95% confidence interval 0.92–1.14; P=0.68). Conclusions. Hepatic encephalopathy and ascites account for more ED visits in frequent than in infrequent attenders. Our findings provide information for those planning outpatient support for patients with cirrhosis. Further research is warranted. |
| format | Article |
| id | doaj-art-69b76326a3904135b317f21fe40be2f6 |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-69b76326a3904135b317f21fe40be2f62025-02-03T05:49:52ZengWileyEmergency Medicine International2090-28402090-28592020-01-01202010.1155/2020/82892758289275Patients with Liver Cirrhosis as Frequent Attenders of Emergency DepartmentsChen-Ju Chuang0Yi-Fang Wu1Kai-Hsiang Wu2Yi-Chuan Chen3Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, TaiwanObjectives. Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding, resulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent attenders of EDs examine general patients without classifying certain subgroups. This study aimed to investigate patients with liver cirrhosis who present repeatedly to the ED. Methods. This was a retrospective, observational cohort study of adult patients with a history of liver cirrhosis presenting to the ED from January 2011 to December 2015. We included patients with cirrhosis whose first ED visit occurred during the study period. We went far back for 20 years and excluded patients with any ED visits (including both cirrhosis and noncirrhosis-related ones) before the study period. We categorized frequent attenders as patients with more than 4 ED visits within 12 months after the first ED visit; infrequent attenders were those who did not meet this criterion. Results. A total of 3513 patients with cirrhosis were included in this retrospective cohort study. Compared with the infrequent attenders, frequent attenders had a higher rate of presentations due to hepatic encephalopathy (15.2% vs 13.7%, P<0.001) and ascites (10% vs 4%, P<0.001). A Kaplan–Meir survival analysis revealed that frequent attendance was not associated with increased mortality during the study period (hazard ratio 1.02, 95% confidence interval 0.92–1.14; P=0.68). Conclusions. Hepatic encephalopathy and ascites account for more ED visits in frequent than in infrequent attenders. Our findings provide information for those planning outpatient support for patients with cirrhosis. Further research is warranted.http://dx.doi.org/10.1155/2020/8289275 |
| spellingShingle | Chen-Ju Chuang Yi-Fang Wu Kai-Hsiang Wu Yi-Chuan Chen Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments Emergency Medicine International |
| title | Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments |
| title_full | Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments |
| title_fullStr | Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments |
| title_full_unstemmed | Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments |
| title_short | Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments |
| title_sort | patients with liver cirrhosis as frequent attenders of emergency departments |
| url | http://dx.doi.org/10.1155/2020/8289275 |
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