For a study, researchers sought to determine determinants of admission following ED visits for gout flares and to highlight impediments to appropriate inpatient gout management.
Between January 1, 2017, and December 31, 2020, ED visits and hospital admissions with a primary diagnosis of gout were examined at two UK-based hospitals. They used logistic regression and survival models to find demographic and clinical determinants of ED disposition (admission or release) and reattendance for gout flares. Case note reviews (n=59), stakeholder meetings, and process mapping were used to collect thorough information on gout management and develop care-optimization methods.
About 23.5% of the 1,220 emergency visits for gout flares needed hospitalization (median length of stay: 3.6 days). During the research period, 10.4% of patients required repeat visits for flares. In multivariate logistic regression models, older age, overnight ED arrival time, greater serum urate (SU), higher C-reactive protein, and higher total white cell count at presentation were significant predictors of ED hospitalization. According to detailed case note evaluations, only 22.6% of patients with previous gout were getting urate-lowering treatment (ULT) at the time of presentation. Although there was some initial diagnostic ambiguity, rheumatology input and synovial aspirates were seldom acquired. By 6 months after discharge, 43.6% of patients were getting ULT; however, few patients had treatment-to-target dosage optimization, and only 9.1% had SU levels of ≤360 μmol/L.
They discovered several predictors of hospitalization for acute gout. If hospitalizations are to be avoided, treatment-to-target optimization of ULT post-hospitalization must be improved.