PT  - JOURNAL ARTICLE
AU  - Mark D. Russell
AU  - Deepak Nagra
AU  - Benjamin D. Clarke
AU  - Sathiyaa Balachandran
AU  - April Buazon
AU  - Amy Boalch
AU  - Katie Bechman
AU  - Maryam A. Adas
AU  - Edward G. Alveyn
AU  - Andrew I. Rutherford
AU  - James B. Galloway
TI  - Hospitalizations for Acute Gout: Process Mapping the Inpatient Journey and Identifying Predictors of Admission
AID  - 10.3899/jrheum.211203
DP  - 2022 Jul 01
TA  - The Journal of Rheumatology
PG  - 725--730
VI  - 49
IP  - 7
4099  - http://www.jrheum.org/content/49/7/725.short
4100  - http://www.jrheum.org/content/49/7/725.full
SO  - J Rheumatol2022 Jul 01; 49
AB  - 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.