Epidemiology of Genito-Urinary Foreign Bodies in the Emergency Room Setting in the United States and its association with Mental Health disorders
Dayron Rodriguez, MD, MPH; Michael Apoj, BS; Archana Rajender, MD; Ricardo Munarriz, MD
Boston Medical Center, Boston University School of Medicine, Boston, MA
BACKGROUND: The epidemiology of genito-urinary foreign bodies has never been examined before in the literature. This study aims to examine the epidemiology, presentation, management, use of financial resources and socio-economic factors in patients presenting with genito-urinary foreign bodies to the emergency departments (ED) nationwide in the United States (US). We further examine the association with mental disorders.
METHODS: ED visits with a primary diagnosis of a genito-urinary foreign body (based on ICD-9 codes) between 2010 and 2014 were abstracted from the Nationwide Emergency Department Sample (NEDS) database (Healthcare Cost and Utilization Project, the U.S. most comprehensive source of hospital care data).
RESULTS: Between 2010 and 2014 a weighted estimate of 120,223 visits to the ED with a genito-urinary foreign body were recorded in the US, which represents a national incidence of 7.6 (+/- 0.2 SE) ED visits per 100,000 persons. No meaningful trends in incidence were observed over the 5-year study period. Male patients (11,526) represented only 9.5% of the cohort, with the most common location being the Vulva/Vagina (87.5%) followed by urethral/bladder (6.77%), penis (4.17%) and GU tract NOS (1.08%). A total of 5,628 ED visits (4.68%) resulted in admission to the hospital. Male patients were more likely to be admitted to the hospital as compared to female patients (24.8% vs 2.1%, p < 0.001). The majority of the patients were between the ages of 18-44yrs (75.8%), with a mean age of 30.28yrs. Mean age of presentation varied by location (vulva/vaginal 29.1 yrs vs. penile 37.6yrs vs urethra/bladder 42.6yrs, p < 0.001). The region of the US with most visits was the South (39.6%), followed by the Midwest 22.6%. Approximately 32.4% of pts had a low income and 25.5% had no form of medical insurance, causing a substantial impact on those patients affected. Costs of stay in the ED averaged $3,769, for those patients admitted the mean length of stay was 2.6 days and the inpatient hospital charges for admitted patients averaged $16,932, however, those with penile or urethra/bladder foreign bodies stayed longer (avg 3.5 days) and incurred a much higher hospital charge (avg $30,071) (p<0.001). Urethral/bladder and penile foreign bodies had a significant association with mental health disorders as compared to vulvar/vaginal foreign bodies (35.6% vs. 6.1%, p <0.001). Mood disorders were more common (27.5%) followed by schizophrenia/psychotic disorders (21.7%) in those patients with mental disorders.
This is the sole study in the literature to date that examines the epidemiology of genito-urinary foreign bodies. These presentations are relatively uncommon but occur at a higher incidence than expected and have a significant impact on healthcare resources. The majority of patients were young females with vulvar/vaginal foreign bodies. Penile and urethral/bladder foreign bodies occurred in slightly older patients and were associated with longer hospital stays and higher hospital costs. Co-morbid mental health disorders were more common in patients with urethral/bladder and penile foreign bodies. Mood disorders and schizophrenia/psychotic disorders were the most common co-morbid mental disorders.
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