Clostridium difficile Infection Related Emergency Department Visits in the United States 2006-2009
Methods: Data were obtained from the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2006-2010. Data were weighted to generate national-level estimates.
Results: For years 2006–2010, a weighted total of 462,160 patients were discharged from the ED with a primary diagnosis of CDI. The rate (cases/100,000 population) of ED visits with CDI as a primary diagnosis increased from 34.08 in 2006 to 42.37 in 2010; this represented an increase of 24.32% (P<0.01). There was an increased trend in the number of ED visits with CDI as a primary diagnosis from 2006–2010 (P<0.01). The highest incidence rate of CDI related ED visits was observed patients ≥ 65 years, while the lowest incidence was in patients 18–24 years. Of the 462,160 patient cohort, 92.48% of cases were admitted as inpatients to the hospital. 17,638 of these patients (4.1%) died during the hospital admit. Inpatient and ED charges increased during the period of the study, from a median of $20,000 (interquartile range [IQR] $25,000) to $24,000 (IQR $27,000) (P<0.01). LOS remained constant at a median of 5 days (IQR 5 days) for this period. Factors associated with an increased risk of hospital admission included female sex, a comorbid burden of ≥3 (aOR 8.25 95% CI 7.89 – 8.62), age ≥65 years (aOR 3.13 95% CI 2.95 – 3.32) and presentation to a metropolitan facility (aOR 2.77 95% CI 2.69 – 2.85). Much smaller risks were associated with female gender (aOR 1.12 95%CI 1.09 – 1.15), Medicaid or Medicare insurance (aOR 1.21 95% CI 1.18 – 1.25), and presentation to a facility in the Southern region of the United States (aOR 1.06 95% CI 1.02 – 1.09).
Conclusion: CDI related ED visits represent a considerable burden on the healthcare system in the United States. Additionally, an increasing trend in the incidence of these cases was observed for the years 2006–2010.
M. Olyaee, None
T. Sferra, None
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