OpenLB
Open Library of Bioscience
Advanced Search
The Journal of rheumatology
07, 2022;49 (7): 725-730.

Hospitalizations for Acute Gout: Process Mapping the Inpatient Journey and Identifying Predictors of Admission.

Mark D Russell, Deepak Nagra, Benjamin D Clarke, Sathiyaa Balachandran, April Buazon, Amy Boalch, Katie Bechman, Maryam A Adas, Edward G Alveyn, Andrew I Rutherford, James B Galloway
Author Information
  1. Mark D Russell: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK. mark.russell@kcl.ac.uk. ORCID
  2. Deepak Nagra: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  3. Benjamin D Clarke: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  4. Sathiyaa Balachandran: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  5. April Buazon: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  6. Amy Boalch: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  7. Katie Bechman: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  8. Maryam A Adas: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  9. Edward G Alveyn: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  10. Andrew I Rutherford: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
  11. James B Galloway: M.D. Russell, MBBChir, Doctoral Research Fellow, D. Nagra, MD, Clinical Research Fellow, B.D. Clarke, MSc, Clinical Research Fellow, S. Balachandran, MBBS, Clinical Research Fellow, A. Buazon, MSc, Clinical Research Fellow, A. Boalch, MBBS, Clinical Research Fellow, K. Bechman, PhD, Clinical Lecturer, M.A. Adas, MBBS, Clinical Research Fellow, E.G. Alveyn, BMBCh, Clinical Research Fellow, A.I. Rutherford, MSc, Consultant Rheumatologist, J.B. Galloway, PhD, Reader in Rheumatology, Centre for Rheumatic Diseases, King's College London, London, UK.
PMID: 35293331 DOI: 10.3899/jrheum.211203

Abstract

OBJECTIVE: To identify predictors of admission following emergency department (ED) attendances for gout flares and to describe barriers to optimal Inpatient gout care.
METHODS: ED attendances and hospital admissions with primary diagnoses of gout were analyzed at 2 UK-based hospitals between January 1, 2017, and December 31, 2020. Demographic and clinical predictors of ED disposition (admission or discharge) and reattendance for gout flares were identified using logistic regression and survival models, respectively. Case note reviews (n = 59), stakeholder meetings, and process mapping were performed to capture detailed information on gout management and to identify strategies to optimize care.
RESULTS: Of 1220 emergency attendances for gout flares, 23.5% required hospitalization (median length of stay: 3.6 days). Recurrent attendances for flares occurred in 10.4% of patients during the study period. In multivariate logistic regression models, significant predictors of admission from ED were older age, overnight ED arrival time, higher serum urate (SU), higher C-reactive protein, and higher total white cell count at presentation. Detailed case note reviews showed that only 22.6% of patients with preexisting gout were receiving urate-lowering therapy (ULT) at presentation. Initial diagnostic uncertainty was common, yet rheumatology input and synovial aspirates were rarely obtained. By 6 months postdischarge, 43.6% were receiving ULT; however, few patients had treat-to-target dose optimization, and only 9.1% achieved SU levels ≤ 360 μmol/L.
CONCLUSION: We identified multiple predictors of hospitalization for acute gout. Treat-to-target optimization of ULT following hospitalization remains inadequate and must be improved if admissions are to be prevented.

Keywords

allopurinol gout healthcare costs hospitalization hyperuricaemia patient education

MeSH Term

Aftercare
Arthritis, Gouty
Gout
Gout Suppressants
Hospitalization
Humans
Inpatients
Patient Discharge
Uric Acid

Chemicals

Gout Suppressants
Uric Acid
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 11

Word Cloud

Created with Highcharts 10.0.0goutEDpredictorsattendancesflareshospitalizationadmissionpatientshigherULTidentifyfollowingemergencycareadmissionsidentifiedlogisticregressionmodelsnotereviews6SUpresentation6%receivingoptimizationOBJECTIVE:departmentdescribebarriersoptimalinpatientMETHODS:hospitalprimarydiagnosesanalyzed2UK-basedhospitalsJanuary12017December312020DemographicclinicaldispositiondischargereattendanceusingsurvivalrespectivelyCasen=59stakeholdermeetingsprocessmappingperformedcapturedetailedinformationmanagementstrategiesoptimizeRESULTS:1220235%requiredmedianlengthstay:3daysRecurrentoccurred104%studyperiodmultivariatesignificantolderageovernightarrivaltimeserumurateC-reactiveproteintotalwhitecellcountDetailedcaseshowed22preexistingurate-loweringtherapyInitialdiagnosticuncertaintycommonyetrheumatologyinputsynovialaspiratesrarelyobtainedmonthspostdischarge43howevertreat-to-targetdose91%achievedlevels≤360μmol/LCONCLUSION:multipleacuteTreat-to-targetremainsinadequatemustimprovedpreventedHospitalizationsAcuteGout:ProcessMappingInpatientJourneyIdentifyingPredictorsAdmissionallopurinolhealthcarecostshyperuricaemiapatienteducation

Similar Articles

Cited By (2)