M1138 Epidemiological Risk Factors for Childhood Onset Inflammatory Bowel Disease in Scotland: A Case-Control Study

G A A b st ra ct s care provider, emergency rooms (ER) may represent a significant point of contact with the healthcare system, and may represent poor maintenance care for their illness . National trends in ER visits by IBD patients have not been explored previously. Methods: We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a complex survey maintained by the National Center for Health Statistics that includes information from hospital emergency departments maintained by the National Center for Health Statistics. IBD-related ER visits were identified using free text or ICD-9-CM codes for Crohn's disease or ulcerative colitis among the reasons for visit for the encounter. Trends in number of annual IBD-related ER visits were analyzed during four time periods 1994-96, 1997-99, 2000-02 and 2003-05. Results: There were a total estimated 28,752 annual ER visits related to IBD during 1994-96 which increased to an estimated 76,374 annual visits during 200305 (+165 %). The increase was much greater for CD (16,575 to 61,598) than UC (12,178 to 14,776), though these estimates were derived from small numbers of patients. During the time period 2003-05, over half the ER visits were from female patients (60%), with over three-quarters being from patients younger than age 50 (81%). Uninsured patients comprised about 17% of visits and patients belonging to non-white races comprised about 26% of visits, a proportion than increased from 1994-96 (11.8%, p < 0.0001). Just fewer than half the patients were admitted to the hospital. Adjusting for US population estimates revealed an average of 26 IBD-related ER visits per 100,000 population. Comparing the ER visits to ambulatory IBD visits showed an increase in rate from 25.5 ER visits per 1000 ambulatory IBD encounters in 1994-96 to 44.6 ER visits per 1000 ambulatory IBD encounters in 200305 (p <0.0001). This proportion was higher for CD (58.1 / 1000) compared to UC (21.4 / 1000) during the period 2003-05. Conclusion: There is increasing utilization of emergency rooms among patients with IBD with ER visits representing a rising proportion of ambulatory IBD encounters. Reasons underlying this phenomenon warrant investigation.