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Hospital revisit rate after a diagnosis of conversion disorder.

TitleHospital revisit rate after a diagnosis of conversion disorder.
Publication TypeJournal Article
Year of Publication2016
AuthorsMerkler AE, Parikh NS, Chaudhry S, Chait A, Allen NC, Navi BB, Kamel H
JournalJ Neurol Neurosurg Psychiatry
Volume87
Issue4
Pagination363-6
Date Published2016 Apr
ISSN1468-330X
KeywordsAdult, Amnesia, Transient Global, Conversion Disorder, Emergency Service, Hospital, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Middle Aged, Patient Discharge, Patient Readmission, Poisson Distribution, Seizures, Treatment Outcome, United States
Abstract

OBJECTIVE: To estimate the hospital revisit rate of patients diagnosed with conversion disorder (CD).

METHODS: Using administrative data, we identified all patients discharged from California, Florida and New York emergency departments (EDs) and acute care hospitals between 2005 and 2011 with a primary discharge diagnosis of CD. Patients discharged with a primary diagnosis of seizure or transient global amnesia (TGA) served as control groups. Our primary outcome was the rate of repeat ED visits and hospital admissions after initial presentation. Poisson regression was used to compare rates between diagnosis groups while adjusting for demographic characteristics.

RESULTS: We identified 7946 patients discharged with a primary diagnosis of CD. During a mean follow-up of 3.0 (±1.6) years, patients with CD had a median of three (IQR, 1-9) ED or inpatient revisits, compared with 0 (IQR, 0-2) in patients with TGA and 3 (IQR, 1-7) in those with seizures. Revisit rates were 18.25 (95% CI, 18.10 to 18.40) visits per 100 patients per month in those with CD, 3.90 (95% CI, 3.84 to 3.95) in those with TGA and 17.78 (95% CI, 17.75 to 17.81) in those with seizures. As compared to CD, the incidence rate ratio for repeat ED visits or hospitalisations was 0.89 (95% CI, 0.86 to 0.93) for seizure disorder and 0.32 (95% CI 0.31 to 0.34) for TGA.

CONCLUSIONS: CD is associated with a substantial hospital revisit rate. Our findings suggest that CD is not an acute, time-limited response to stress, but rather that CD is a manifestation of a broader pattern of chronic neuropsychiatric disease.

DOI10.1136/jnnp-2014-310181
Alternate JournalJ. Neurol. Neurosurg. Psychiatry
PubMed ID25855400

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