Recurrent use of the Emergency Department in patients with anxiety disorder

F. Buccelletti, V. Ojetti, G. Merra, A. Carroccia, D. Marsiliani, F. Mangiola, G. Calabrò, P. Iacomini, G. Zuccalà, F. Franceschi

Emergency Department, School of Medicine, Catholic University of the Sacred Heart, “Agostino Gemelli” Hospital, Rome, Italy. merra@libero.it

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• Emergency Medicine

OBJECTIVE: Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks. During panic attacks, patients (pts) refer to the Emergency Department (ED). The diagnostic work-up for any panic attack is expensive since symptoms at presentation mimic other diseases such acute coronary syndrome or neurological emergencies.
The aim of the present study was to describe a 10 years cohort of pts diagnosed with panic disorder in the ED in terms of ED visit recurrence.

METHODS: Case-control study, in a tertiary care, involving pts presenting to the ED and diagnosed with panic attack according to the International Classification of Diseases 9nt Revision (ICD-9). From January 2001 to Dec 2009 were extracted from the electronic clinical database 469 pts and were divided into “recurrent ED visit” (multiple ED access for panic attack) (N=361) and “no recurrent ED visit” (only one ED access for panic attack in 9 years) (N=108).

RESULTS: At univariate analysis cases and controls differed for male prevalence (p < 0.01), neurological symptoms at presentation (p = 0.02) and history of other psychiatry disorder (p < 0.01).
In multivariate analysis independent predictors were male gender, age under 40 year old, palpitations at presentations, 1 or more cardiovascular risk factors and previous other psychiatry conditions.

CONCLUSIONS: Male under 40 years old with palpitations or cardiovascular risk and other psychiatric diseases, have a higher recurrence of panic attacks. General psychiatric evaluation and treatment with benzodiazepine in ED is not useful to prevent recurrences. Identifying those patients at high risk of panic attack and ED visit recurrence might be useful to establish ad-hoc interventions, improve patients’ morbidity and save precious resources.

Published on: 2013/02/15

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