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Hospitalization in amyotrophic lateral sclerosis

Causes, costs, and outcomes

From the Division of Pulmonary and Critical Care, Department of Medicine (Drs. Lechtzin, Wiener, and Diette), and Department of Neurology (Dr. Chaudhry and L. Clawson), Johns Hopkins University School of Medicine, and Department of Epidemiology (Dr. Diette), Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD.

Address correspondence and reprint requests to Dr. N. Lechtzin, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 910, Baltimore, MD 21287; e-mail: nlechtz{at}welch.jhu.edu

OBJECTIVE: As ALS progresses, extensive supportive care is required, including multidisciplinary outpatient care and hospitalization. The authors studied the causes, health care utilization, and outcomes for hospitalized patients with ALS.

METHODS: With use of the 1996 Nationwide Inpatient Sample, an administrative database representing 20% of U.S. hospitals, 1,600 hospitalizations in patients with ALS were identified and compared with 5,364,728 non-ALS hospitalizations.

RESULTS: The most common concurrent diagnoses in patients with ALS were dehydration and malnutrition (574 patients, 36%), pneumonia (507 patients, 32%), and respiratory failure (398 patients, 25%). Only 38% of patients with ALS were discharged to home without home health care compared with 73% of patients with non-ALS. Fifteen percent of patients with ALS died in the hospital compared with 3% of non-ALS patients. The average length of hospital stay and charges were greater for patients with ALS than for non-ALS patients (8.4 days and $19,810 for ALS patients and 5.4 days and $11,924 for non-ALS patients). Mortality was significantly associated with emergency room admission (versus nonemergency admission; OR = 1.60), increasing age (per year; OR = 1.03), respiratory failure (OR = 3.37), and pneumonia (OR = 2.02) (p < 0.01 for all comparisons).

CONCLUSIONS: Patients with ALS have lengthy and costly hospital admissions, a high in-hospital mortality rate, and few routine discharges. Recognition of the issues that precipitate hospitalization may allow development of preventive strategies.

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