A. A. Shah1,2, S. Zafar1, R. Gray2, B. Pockaj2, E. Cornwell1, L. Wilson1, N. Wasif2 1Howard University College Of Medicine,Surgery,Washington, DC, USA 2Mayo Clinic In Arizona,Surgery,Phoenix, AZ, USA
Introduction: Utilization of emergency department (ED) services by cancer patients has not been well studied. Our objective with this study was to identify common reasons for ED visits in patients with cancer and identify predictors for subsequent admission.
Methods: The Nationwide Emergency Department Sample (2009-2012) was queried for patients with a diagnosis of malignant cancers (ICD-9-CM diagnosis codes; 140-208.9, 238.4, 289.8) as a secondary diagnosis. Of these the five most common cancers in the United States, as identified by the American Cancer Society, were identified. Primary diagnosis codes were examined for common reasons for presentation to the ED. Descriptive analysis was then performed to describe patient demographics, payor status, discharge disposition, hospital characteristics and outcomes. Multivariable logistic regression analyses for inpatient admission were used to identify risk factors from among the following domains age, gender, insurance status, income, and year of admission for all cancer patients and for each of the commonest cancers (Table).
Results: A total of 2,279,822 records were analyzed representing 2% of ED visits and weighted to represent 10,178,361 visits nationally. Mean age was 63.9(±17.9) with a slight female dominance. Medicare was the primary payor for 55.6% and Medicaid for 12.5%, whereas 24.1% had private insurance. Of the 5 most common cancers, patient with lung cancer comprised 11.8% of ED visits followed by prostate(6.5%), breast(5.7%), colorectal(4.6%), and bladder(1.9%) cancers. Around 65.0% were admitted to the hospital and 31.1% were discharged from the ED. Geriatric patients and those in the highest income quartile are at higher risk of hospital admission. However, female patients, the uninsured and those visiting on the weekends were less likely to be admitted to the hospital (table). The five most common reasons for ED visits included pneumonia(3.5%), abdominal pain (3.5%), urinary tract infection(2.1%), acute exacerbation of bronchitis(1.7%) and acute kidney injury(1.6%). Mortality was 0.4% and 4.0% in the ED and inpatient, respectively. Amongst the five most common cancers, patients with lung cancers (OR[95%CI]:2.07[2.04-2.10]) had the highest odds likelihood of admission followed by patients with bladder cancer (OR[95%CI]:1.71[1.67-1.75]) and colorectal cancer (OR[95%CI]:1.50[1.47-1.52]).
Conclusion: Cancer patients represent an important patient demographic treated in the ED every year. The results of this study help identify the spectrum of clinical conditions cancer patients present with. Recognizing patients at risk for admission can help expedite ED triage to reduce wait times, ensure timely healthcare delivery and identify potentially avoidable admissions.
