J Rheumatol. 2022 Mar 15:jrheum.211203. doi: 10.3899/jrheum.211203. Online ahead of print.
ABSTRACT
OBJECTIVE: To identify predictors of admission following emergency attendances for gout flares, and describe barriers to optimal inpatient gout care.
METHODS: Emergency department (ED) attendances and hospital admissions with primary diagnoses of gout were analyzed at two UK-based hospitals between 1st January 2017 and 31st December 2020. Demographic and clinical predictors of ED disposition (admission or discharge) and re-attendance 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 identify strategies to optimize care.
RESULTS: Of 1,220 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, higher CRP and higher total white cell count at presentation. Detailed case-note reviews showed that only 22.6% of patients with pre-existing gout were receiving urate-lowering therapy (ULT) at presentation. Initial diagnostic uncertainty was common, yet rheumatology input and synovial aspirates were rarely obtained. By six months post-discharge, 43.6% were receiving ULT; however, few patients had treat-to-target dose optimization, and only 9.1% achieved a urate ≤360 micromol/L.
CONCLUSION: We identified multiple predictors of hospitalization for acute gout. Prescription of ULT and treat-to-target optimization following hospitalization remain inadequate, and must be improved if admissions are to be prevented.
PMID:35293331 | DOI:10.3899/jrheum.211203