Inflammatory Bowel Disease and the Emergency Department: Risk Factors for Repeated Visits and Role of CT Imaging: 580

Introduction: ED visits account for a significant portion of health care utilization in IBD pts. However, there is a lack of standardization of appropriate ED care for IBD pts. This increases cost with repeated diagnostic testing or medication use associated with negative outcomes. Interventions to improve IBD pts ED care are lacking, unlike other chronic medical conditions. We aim to characterize IBD pts' ED care and identify risk factors for repeated ED visits. Methods: ED visits from 01/2012-10/2017 were identified in the electronic health record. Pts presenting to the ED for their IBD diagnosis were included. Disease, treatment, and pt characteristics were recorded. Psychiatric comorbidities, ED tests and treatments were noted. Abdominal CT scan positive finding was defined as presence of fistula, abscess, or pSBO. The Michigan CT (MI-CT) score (Govani 2015) was calculated for pts as (“very low” risk or “not low” risk). Descriptive statistics and binary logistic regression models were used. A generalized linear mixed effects model was used to compare Michigan score and CT findings. Random intercepts were employed per pt to account for multiple admissions over the observation period. Results: 249 IBD pts had 515 unique ED visits from 2012 to 2017(173 CD, 74 UC). 46/249 pts(18%) were high utilizers with >2 ED visits. 65% of pts were on no therapy or 5-ASA, 11% IMM therapy, 24% biologics, and 26% of patients were on steroids at presentation. Insurance status was commercial(45%), uninsured(10%), Medicare(22%), and Medicaid(23%). In 515 unique visits, 44% of the time pts underwent CT scan. Of 227 CT scans, only 31% had a positive finding. CT imaging decision did not correlate with MI-CT score, and positive findings on CT were not associated with a high-risk score. Crohns pts were more likely to have a positive finding than UC pts(36.7% vs 9.1%, p=0.003). Narcotics were given in 66%, antibiotics in 15% and steroids in 8% of ED visits. Pts who received narcotics (OR 1.95; CI 0.99-3.83; p=0.05) and pts with underlying psychiatric diagnoses(OR 2.05; CI 1.03-4.05; p=0.04) were more likely to have repeat ED visits. IBD immunosuppression was not associated with recurrent ED visits. Conclusion: Programs that address IBD pts' psychiatric comorbidities and pain/discomfort may reduce repeated ED visits. Curtailing the use of CT imaging in the ED of Crohns pts and especially UC pts is warranted. Reducing IBD pt's ED visits should improve patient outcomes, reduce cost, and be a quality metric.580_A Figure 1 No Caption available.580_B Figure 2. Binary logistic regression model results examining chronic ED use