0490: Analysis of Emergency Department Visits by Patients with Giant Cell Arteritis: A National Population-based Study

Ehizogie Edigin¹, Amy Trang², Chinenye Osuorji³, Solomon Anighoro⁴, Precious Eseaton⁵, Christopher Hino¹, Osahon Idolor⁶, Nneka Chukwu⁷, Anum Akhlaq⁸ and Mehrnaz Hojjati¹, ¹Loma Linda University Health, Loma Linda, CA, ²Rush University Medical Center, Chicago, IL, ³Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, ⁴St. Helens and Knowsley Teaching hospitals NHS Trust, Prescot, England, United Kingdom, ⁵University of South Wales, Cardiff, Wales, United Kingdom, ⁶Piedmont Athens Regional, Atlanta, GA, ⁷Nuvance Health, Poughkeepsie, ⁸University of Mississippi Medical Center, Jackson, MS

Background/Purpose: Giant Cell Arteritis (GCA) is the most common vasculitis in patients older than 50 years of age. GCA has significant economic burden and increases health care utilization such as Emergency Department (ED) visits and hospitalization. There is scarcity of large national level data on the reasons for presentation to the ED among patients with GCA in the United States (US). This study aims to outline the most common reasons for ED presentation among patients with GCA. We also aim to study baseline demographic characteristics, ED outcomes among patients who presented to the ED principally due to GCA.

Methods: We obtained data from the National Emergency Department Sample (NEDS) 2018 database. The NEDS is the largest publicly available ED database in the US. The NEDS is a nationally representative stratified sample of 20% of US hospital owned EDs. The 2018 NEDS contains about 35.8 million unweighted ED visits, which is roughly estimated to be about 143 million ED visits. Each ED visit in the NEDS has a principal diagnosis (the main reason for the visit) and can have up to 34 secondary diagnoses (any other diagnosis other than the principal diagnosis). We searched for ED visits for adult patients aged ≥50, with any (i.e either principal or secondary) diagnosis of GCA using ICD-10 codes "M315" or "M316". STATA, version 16 was used for analysis. By using a "rank" command in STATA, the most common principal discharge diagnoses were divided into categories based on organ system, and the most common specific principal discharge diagnoses were recorded for ED visits among patients with any diagnosis of GCA in descending order of frequency. We then outlined baseline demographic characteristics and ED visit outcomes of patients who presented to the ED with a principal diagnosis of GCA.

Results: Out of 143 million ED visits in 2018, 20,886 (0.015%) of these visits were for patients with GCA. Rheumatologic, cardiovascular (CV), infections and respiratory were the most common reasons for presentation to the ED for patients with GCA. GCA, headaches, infectious etiologies such as sepsis, pneumonia, urinary tract infections and hypertensive heart disease with chronic kidney disease and heart failure were the most common specific principal discharge diagnosis of GCA patients who presented to the ED. See Table 1 and Figure 1Among GCA patients who presented to the ED, 3888 of these visits were principally because of GCA. ED visits principally because of GCA were predominantly elderly (mean age of 73 years), females (67.7%), admitted (59.2%), Medicare insured (77.2%), charlson comorbidity index score of less than 3 (78.4%) and presented to metropolitan teaching hospitals in the south. See Table 2.

Conclusion: GCA patients are most likely to present to the ED due to their underlying GCA. Infections and CV are also common reasons for presentation to the ED. GCA patients who presented to the ED principally due to GCA are most likely to be elderly white females and admitted. Optimizing management of GCA and its comorbidities, measures for prevention and early detection of infections while on immunosuppressants in the outpatient setting are important in preventing ED visits and hospital admissions of GCA patients.
Table 1: ICD-10 code categories and specific principal discharge diagnosis for Emergency Department visit of patients with Giant Cell Arteritis.

For emergency department visits of patients with any (i.e either principal or secondary) diagnosis of Giant Cell Arteritis.
COPD: Chronic obstructive pulmonary disease


Table 2: Baseline characteristics of patients who presented to the Emergency Department principally due to Giant Cell Arteritis in the United States in 2018.
Abbreviations: * Emergency department visits for patients aged ≥ 50 years with Giant Cell Arteritis as the “principal” diagnosis, LOS: Length of inpatient stay for those admitted, Charge: charge for Emergency department visit, USD: United States dollars, income** Median household income national quartile for patient’s Zip code, SNF: Skilled nursing facility, COPD: Chronic obstruction pulmonary disease


Figure 1: Pareto chart of ICD-10 code categories in descending order of frequency for Emergency Department visit of patients with Giant Cell Arteritis. Line on the secondary axis plots the cumulative percentages of each ICD-10 code categories

Abbreviations: Hema/Onc: Neoplasms & diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, Endo: Endocrine, nutritional and metabolic diseases, Psych: Mental, behavioral and neurodevelopmental disorders, Neuro: Diseases of the nervous system, CVS: Diseases of the circulatory system, Respiratory: Diseases of the respiratory system, GI: Diseases of the digestive system, Rheum: Diseases of the musculoskeletal system and connective tissue, GU: Diseases of the genitourinary system, others: Symptoms, signs, and abnormal clinical laboratory findings, not elsewhere classified, Health services: Factors influencing health status and contact with health services

Disclosures: E. Edigin, None; A. Trang, None; C. Osuorji, None; S. Anighoro, None; P. Eseaton, None; C. Hino, None; O. Idolor, None; N. Chukwu, None; A. Akhlaq, None; M. Hojjati, None.