Clinical Investigations Respiration 2014;88:298–306 DOI: 10.1159/000365996
Received: December 18, 2013 Accepted after revision: July 18, 2014 Published online: September 10, 2014
Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation José M. Quintana a, f Cristóbal Esteban b, f Susana Garcia-Gutierrez a, f Urko Aguirre a, f Nerea Gonzalez a, f Iratxe Lafuente a Marisa Bare c, f Nerea Fernandez de Larrea d, f Francisco Rivas-Ruiz e, f for the IRYSS-COPD Group a
Unidad de Investigación, and b Servicio de Neumologia, Hospital Galdakao-Usansolo, Galdakao, c Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, d Departamento de Salud, Madrid, e Unidad de Investigación, Hospital Costa del Sol, Malaga, and f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
Abstract Background: Limited information is available regarding the factors related to short-term hospital admission following an exacerbation of chronic obstructive pulmonary disease (eCOPD). Objectives: The aim of this study was to identify variables related to short-term admission in patients with an eCOPD. Methods: This was a prospective cohort study of patients with an eCOPD who attended an emergency department (ED) at 1 of 16 hospitals. Information on possible predictor variables was recorded during the ED stay, 24 h after admission to the hospital or after ED discharge home, and at hospital discharge or 1 week later if discharged home from the ED. An admission after an eCOPD within 2 months was the outcome of interest. Multivariate models were employed for patients admitted to the hospital or discharged home from the ED. Results: For patients discharged home from the ED, eCOPD-related hospital admissions in the previous year [odds ratio (OR) 1.98 and 2.33], pCO2 at ED admission (ORs
© 2014 S. Karger AG, Basel 0025–7931/14/0884–0298$39.50/0 E-Mail [email protected] www.karger.com/res
2.02 and 2.90), the number of ED visits within 1 week of the index ED visit (OR 5.14) and dyspnea level 1 week after the index ED visit (ORs 2.66 and 1.40) were predictors of shortterm admission [area under the curve (AUC) 0.82]. For patients admitted to the hospital during the index ED visit, baseline FEV1% (ORs 1.32 and 1.88), eCOPD-related hospital admissions in the previous year (ORs 1.28 and 2.51), severe baseline dyspnea (OR 2.57) and dyspnea level 1 week after the index ED visit (ORs 2.15 and 1.74) were predictors of short-term readmission (AUC 0.73). Conclusions: Just a few easily recorded parameters may allow clinicians to identify patients at a higher risk of short-term readmission and establish preventive strategies. © 2014 S. Karger AG, Basel
Introduction
In developed countries, chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Much of its impact is related to exacerbations – sudden worsening of symptoms that may last for several days – which are part of the evolution of the disease in some patients [1, 2]. Exacerbations are also related Dr. José M. Quintana Unidad de Investigación, Hospital Galdakao-Usansolo Barrio Labeaga s/n ES–48960 Galdakao (Spain) E-Mail josemaria.quintanalopez @ osakidetza.net
Downloaded by: University of Tokyo 157.82.153.40 - 5/20/2015 12:39:00 PM
Key Words COPD exacerbations · Short-term hospital admissions · Emergency department evaluation · Predictive factors · Prospective cohort study
Methods This prospective cohort study included 16 hospitals registered with the Spanish National Health Service (SNS). The majority of the Spanish population (99.8%) is covered by the SNS. All centers present similar technological and human resources. So far, all individuals covered by the SNS have free access to a primary care physician and to the ED of the hospitals. Patients with an eCOPD attending the ED of any of these hospitals between June 2008 and September 2010 were informed of the goals of the study and invited to voluntarily participate. In order to take part in the study, a patient had to provide informed consent. All information was kept confidential. The institutional review boards of the participating hospitals approved this project. A more detailed description of the study protocol has been published previously [13]. Patients were eligible for the study if they presented to the ED of 1 of the hospitals with symptoms consistent with an eCOPD. COPD was confirmed if the patient had a FEV1/FVC ratio of 7.35 1,884 (87.51) 226 (10.50) 7.26 – 7.35
Received: December 18, 2013 Accepted after revision: July 18, 2014 Published online: September 10, 2014
Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation José M. Quintana a, f Cristóbal Esteban b, f Susana Garcia-Gutierrez a, f Urko Aguirre a, f Nerea Gonzalez a, f Iratxe Lafuente a Marisa Bare c, f Nerea Fernandez de Larrea d, f Francisco Rivas-Ruiz e, f for the IRYSS-COPD Group a
Unidad de Investigación, and b Servicio de Neumologia, Hospital Galdakao-Usansolo, Galdakao, c Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, d Departamento de Salud, Madrid, e Unidad de Investigación, Hospital Costa del Sol, Malaga, and f Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
Abstract Background: Limited information is available regarding the factors related to short-term hospital admission following an exacerbation of chronic obstructive pulmonary disease (eCOPD). Objectives: The aim of this study was to identify variables related to short-term admission in patients with an eCOPD. Methods: This was a prospective cohort study of patients with an eCOPD who attended an emergency department (ED) at 1 of 16 hospitals. Information on possible predictor variables was recorded during the ED stay, 24 h after admission to the hospital or after ED discharge home, and at hospital discharge or 1 week later if discharged home from the ED. An admission after an eCOPD within 2 months was the outcome of interest. Multivariate models were employed for patients admitted to the hospital or discharged home from the ED. Results: For patients discharged home from the ED, eCOPD-related hospital admissions in the previous year [odds ratio (OR) 1.98 and 2.33], pCO2 at ED admission (ORs
© 2014 S. Karger AG, Basel 0025–7931/14/0884–0298$39.50/0 E-Mail [email protected] www.karger.com/res
2.02 and 2.90), the number of ED visits within 1 week of the index ED visit (OR 5.14) and dyspnea level 1 week after the index ED visit (ORs 2.66 and 1.40) were predictors of shortterm admission [area under the curve (AUC) 0.82]. For patients admitted to the hospital during the index ED visit, baseline FEV1% (ORs 1.32 and 1.88), eCOPD-related hospital admissions in the previous year (ORs 1.28 and 2.51), severe baseline dyspnea (OR 2.57) and dyspnea level 1 week after the index ED visit (ORs 2.15 and 1.74) were predictors of short-term readmission (AUC 0.73). Conclusions: Just a few easily recorded parameters may allow clinicians to identify patients at a higher risk of short-term readmission and establish preventive strategies. © 2014 S. Karger AG, Basel
Introduction
In developed countries, chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Much of its impact is related to exacerbations – sudden worsening of symptoms that may last for several days – which are part of the evolution of the disease in some patients [1, 2]. Exacerbations are also related Dr. José M. Quintana Unidad de Investigación, Hospital Galdakao-Usansolo Barrio Labeaga s/n ES–48960 Galdakao (Spain) E-Mail josemaria.quintanalopez @ osakidetza.net
Downloaded by: University of Tokyo 157.82.153.40 - 5/20/2015 12:39:00 PM
Key Words COPD exacerbations · Short-term hospital admissions · Emergency department evaluation · Predictive factors · Prospective cohort study
Methods This prospective cohort study included 16 hospitals registered with the Spanish National Health Service (SNS). The majority of the Spanish population (99.8%) is covered by the SNS. All centers present similar technological and human resources. So far, all individuals covered by the SNS have free access to a primary care physician and to the ED of the hospitals. Patients with an eCOPD attending the ED of any of these hospitals between June 2008 and September 2010 were informed of the goals of the study and invited to voluntarily participate. In order to take part in the study, a patient had to provide informed consent. All information was kept confidential. The institutional review boards of the participating hospitals approved this project. A more detailed description of the study protocol has been published previously [13]. Patients were eligible for the study if they presented to the ED of 1 of the hospitals with symptoms consistent with an eCOPD. COPD was confirmed if the patient had a FEV1/FVC ratio of 7.35 1,884 (87.51) 226 (10.50) 7.26 – 7.35
