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Research paper
Hospital revisit rate after a diagnosis of conversion disorder
  1. Alexander E Merkler1,
  2. Neal S Parikh1,
  3. Simriti Chaudhry2,
  4. Alanna Chait2,
  5. Nicole C Allen3,
  6. Babak B Navi1,4,
  7. Hooman Kamel1,4
  1. 1Department of Neurology, Weill Cornell Medical College, New York, New York, USA
  2. 2Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
  3. 3Department of Psychiatry, Montefiore Medical Center, Bronx, New York, USA
  4. 4Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Alexander E Merkler, Department of Neurology, Weill Cornell Medical College, 525 East 68th Street, Room F610, New York, NY 10065, USA; alm9097{at}nyp.org

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.

  • NEUROPSYCHIATRY
  • EPIDEMIOLOGY
  • PSYCHIATRY

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