Symptom-Based Hospitalization Risk Differs Between Ulcerative Colitis and Crohn’s Disease: A Nationwide Emergency Department Study

Presenting symptoms guide emergency department (ED) triage and admission decisions in inflammatory bowel disease (IBD), but whether symptoms have similar predictive value in ulcerative colitis (UC) and Crohn’s disease (CD) remains unclear. We examined disease-specific associations between presenting symptoms and hospital admission in adult IBD patients visiting the ED. We analyzed 33,246 ED visits for IBD (25,750 CD; 7,496 UC) among adults (≥ 20 years) using South Korea’s National Emergency Department Information System (2019–2023). Multivariable logistic regression with interaction terms examined associations between five presenting symptoms (abdominal pain, gastrointestinal bleeding, fever, diarrhea, and vomiting) and hospital admission, adjusting for age, sex, triage acuity, and ED level. Despite UC patients having higher overall admission rates than CD patients (55.0% vs. 30.4%), specific symptoms showed stronger associations with admission in CD. Multivariable logistic regression revealed gastrointestinal bleeding (adjusted odds ratio [aOR] 3.54 vs. 1.65), fever (aOR 2.51 vs. 1.38), and vomiting (aOR 1.13 vs. 0.46) were more strongly associated with admission in CD than UC, while abdominal pain showed the opposite pattern (aOR 0.40 vs. 0.60; all interactions p < 0.001). Presenting symptoms have markedly different associations with hospital admission in UC versus CD. While UC patients have higher overall admission rates, specific symptoms such as GI bleeding and fever serve as stronger predictors of hospitalization in CD, providing evidence-based insights for emergency department risk stratification in IBD patients.