Emergency Department Utilization in People with Gout: A 10-Year Population-Based Analysis of Visits in Alberta

Objectives The significant increase in gout prevalence in the population is anticipated to have effects on health system use, including acute care visits by patients with gout. Our objective was to analyze trends in ED visits for any reason among patients with gout in Alberta. Methods We used linked population-based administrative datasets to retrospectively assess ED use for any reason by persons meeting the case definition for incident gout over a 10-year period (2007/2008-2017/2018). We estimated the annual frequency of ED use and assigned the most responsible diagnosis code to broader diagnostic groupings. We analyzed visit characteristics, acuity at presentation using the Canadian Triage Acuity Scale (CTAS), and disposition using descriptive statistics. All results were additionally stratified by biological sex (male/female) and geographic location of residence (urban/rural). Results 646,926 ED visits were made by 88,373 individuals with gout in Alberta. We observed a 69% increase in ED use over the study period by the cohort although the mean number of visits per person per year decreased over the 10-year period, from 1.06 (95% CI 1.03, 1.09) in fiscal year 2008 to 0.79 (95% CI 0.77, 0.80) in fiscal year 2017. The majority of visits for any diagnosis were assessed at CTAS 3 “Urgent” (32.5%) and CTAS 4 “Less urgent” (32.2%). The proportion of visits triaged as ‘Urgent’ increased over the 10-year period, from 25.9% of all visits in 2008, to 37.9% in 2017. Visits specifically for gout accounted for 5.7% of all visits, primarily triaged as CTAS 3 (23.2%) and CTAS 4 (56%). Injuries and infection each accounted for ~11% of all visits. Almost 1 in 5 (17%) visits resulted in admission, although just 1.3% of admissions were for gout flares specifically. About one-fifth (19.6%) of individuals discharged from an initial ED visit had a minimum of 1 ED return visit within 72 hours. Where the first visit was coded as inflammatory arthritis, 42.2% of return visits were for the same diagnosis. Female patients more frequently required hospital admission (20.4% vs males 15.7%), and while urban residents had an increased frequency of ED visits (25.6% vs 9.2%), they were less likely to be admitted to hospital than rural residents (11.4% vs rural 20.0%). Conclusion Acute care utilization by persons with gout has increased significantly over time, with lower-acuity presentations dominating out-related ED visits suggesting unmet ambulatory care needs.