Hospitalization in amyotrophic lateral sclerosis

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.