437 Emergency department usage and patient characteristics for guttate psoriasis

Background: Guttate psoriasis (GP) is a distinct and less common form of psoriasis. GP typically presents with acute generalized lesions and can sometime be chronically severe, which may prompt evaluation and management in the emergency care setting. Yet, little is known about the prevalence, demographics, and cost of emergency care for patients with GP in the United States (US). Objective: To determine the prevalence, risk factors and cost of emergency care for GP in the United States. Methods: We analyzed data from National Emergency Department Sample 2015-2019, including a 20% cross-sectional sample of US emergency department visits (N=142,715,425). Primary or secondary diagnoses of GP were identified using the International Classification of Disease-10-Clinical Modification code L40.4. Results: The mean annual incidence of ED visits with a primary diagnosis of GP was 3.2-6.1 cases per 1 million persons. The incidence of ED visits for GP increased from 2015 to 2017, then decreased until 2019. ED visits with a primary diagnosis of GP versus ED visits without were associated with having lower median household income quartile (P=0.01), no insurance (P<0.0001), and being male (P=0.009) and autumn season (P=0.02). Only 3.8% of GP patients with GP were admitted as inpatients from the ED compared with 13.8% of patients without GP (Chi-square, P<0.0001). The geometric mean cost of ED care for patients with a primary diagnosis of GP was approximately one-fourth of the cost in patients without GP ($1,163 vs. $4,052). [JS1] The total cost of ED care for patients with a primary diagnosis of GP is $2,653,216 over the 5 year period. The excess cost of secondary GP compared to no GP is on average $272 per patient. Conclusion: GP frequently leads to ED visits in the US contributing to substantial healthcare costs. Most cases of GP that presented to the ED were uncomplicated and did not result in inpatient hospitalization.