Emergency department admissions for uncomplicated diverticulitis: a nationwide study

Background: This study aims to investigate trends in emergency department (ED) visits and hospital admissions and to determine predictors of admission from the ED for patients with a primary diagnosis of acute uncomplicated diverticulitis (AUD). Methods: Weighted ED visits for a primary diagnosis of AUD (based on International Classification of Diseases, 9th Revision and 10th Revision, [ICD-9 and ICD-10] codes) were captured from 2006 to 2017 using the Nationwide Emergency Department Sample (NEDS). A %2 test of independence was used to compare patient and hospital characteristics between admitted and nonadmitted patients. A multiple logistic regression was used to determine odds of admission. Results: In 2006, a total of 237 445 patients presented to the ED with AUD, of whom 131 758 (55.5%) were admitted. In 2017, 392 316 patients presented to the ED with AUD, of whom 99 775 (2 5.4%) were admitted. This represents an overall 65.2% increase in the number of cases but a 30.1% decrease in the proportion admitted. In addition to year of presentation (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.85-0.85), age (18-44 yr: ref; 45-64 yr: OR 0.90, 95% CI 0.89-0.92; 65-84 yr: OR 1.10, 95% CI 1.07-1.12; > 85 yr: OR 2.36, 95% CI 2.23-2.44), insurance status (uninsured or self-insured: ref; private insurance: OR 1.21, 95% CI 1.19-1.24; Medicare: OR 1.26, 95% CI 1.23-1.30; Medicaid: OR 1.15, 95% CI 1.11-1.18; other: OR 1.45, 95% CI 1.40-1.50), number of comorbidities (0: REF; 1: OR 1.80, 95% CI 1.75-1.84; 2: OR 2.93, 95% CI 2.86-3.00; > 3: OR 10.73, 95% CI 10.5210.95), hospital location (metropolitan: OR 1.31, 95% CI 1.291.33) and hospital region (west: ref; northeast: OR 1.89, 95% CI 1.86-1.93; midwest: OR 1.27, 95% CI 1.25-1.29; south: OR 1.36, 95% CI 1.59-1.39) were strongly associated with admission. Conclusion: While the number of cases of AUD presenting to the ED continues to rise, the proportion of patients admitted is declining. In addition to year of presentation, older age, insurance status and hospital characteristics are strongly associated with admission.