Emergency Department Utilization in Patients with Neurogenic Bladder: Contemporary Burden and National Trends in Prevalence, Inpatient Admission and Associated Charges 2006-2011

To quantify the national burden of neurogenic bladder disease, a chronic debilitating condition associated with frequent hospital visits, in the contemporary emergency care setting.

Relying on the Nationwide Emergency Department Sample, 2006-2011, patients presenting to the emergency department (ED) with neurogenic bladder were abstracted utilizing ICD-9 codes. National trends in ED presentation, subsequent inpatient admission versus discharge and associated charges were examined using the estimated annual percent change methodology.

Over the study period, a total of 875,066 patients with neurogenic bladder were seen in the ED, of which 538,532 (61.5%) were admitted. Total and median ED charges increased at an annual rate of 36.66% (p<0.001) and 13.24% (p<0.001), respectively, with total ED charges amounting to 87.48 million USD in the year 2011. Annual ED utilization also increased, although at a slower rate, 1.89% (p=0.017). Inpatient admissions decreased at an annual rate of 3.67% (p<0.001), while the use of long-term care facilities increased, 11.82% (p=0.005).

Total ED charges are increasing at a dramatic rate driven by increasing utilization of the ED as an entry point to healthcare as well as increasing per visit charges. Encouragingly, the rates of inpatient admission are decreasing, likely secondary to improved triaging in the ED and increased utilization of long-term care facilities. It remains to be seen however whether the increased spending in the ED for better triaging and investment in long-term care facilities will translate into an overall economic benefit by reducing inpatient charges or not.

Urology. 2017 Jul 26 [Epub ahead of print]

Akshay Sood, Jessica Phelps, Isaac Palma-Zamora, Tarun Jindal, Firas Abdollah, Ardiana Vuljaj, Jesse D Sammon, Quoc-Dien Trinh, Mani Menon, Humphrey Atiemo

VCORE, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Center for Surgery and Public Health, Division of Urology, Brigham and Women's Hospital, Boston, MA. Electronic address: ., VCORE, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI., VCORE, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI; Center for Surgery and Public Health, Division of Urology, Brigham and Women's Hospital, Boston, MA., Center for Surgery and Public Health, Division of Urology, Brigham and Women's Hospital, Boston, MA.