The clinical journey of patients with a severe exacerbation of chronic obstructive pulmonary disease (COPD): from the ambulance to the emergency department to the hospital ward.

Autor: Sneath E; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Emergency Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia., Tippett V; School of Clinical Sciences, Queensland University of Technology, Queensland, Australia., Bowman RV; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia., Fong KM; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia., Hazell W; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Emergency Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia., Masel PJ; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia., Bunting D; Information Support, Research & Evaluation, Queensland Ambulance Service, Queensland, Australia., Watt K; Information Support, Research & Evaluation, Queensland Ambulance Service, Queensland, Australia., Yang IA; Faculty of Medicine, The University of Queensland, Queensland, Australia.; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia.
Jazyk: angličtina
Zdroj: Journal of thoracic disease [J Thorac Dis] 2022 Dec; Vol. 14 (12), pp. 4601-4613.
DOI: 10.21037/jtd-22-328
Abstrakt: Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are acute complications that often require emergency management by ambulance, emergency department (ED) and hospital services. Given the high mortality and morbidity of exacerbations, better understanding of the epidemiology of patients with COPD presenting to EDs is needed, as well as identification of predictive factors for adverse outcomes from exacerbations.
Methods: This retrospective observational study involved patients who presented to an ED in the state of Queensland and received either an ED or hospital diagnosis of COPD in 2015 and 2016. Administrative data from ambulance, ED, hospital and death registry databases were linked to provide a comprehensive picture of the emergency healthcare pathway for these patients.
Results: A total of 16,166 patients (49% female, 51% male) had 29,332 presentations to an ED in Queensland and received either an ED or hospital principal diagnosis of COPD during 2015 and 2016. These patients had a significant comorbidity burden with 54% having two or more comorbidities. Sixty-nine percent of ED presentations involved ambulance transport, and most of these (74%) involved administration of oxygen therapy and/or other medications by paramedics. Prehospital oxygen administration and ≥10 comorbidities were associated with >1 admission [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1-1.5; OR 4.3, 95% CI: 3.1-5.8, respectively], greater than average lengths of stay (OR 1.5, 95% CI: 1.3-1.6; OR 22.1, 95% CI: 18.1-27.2) and mortality (OR 1.6, 95% CI: 1.5-1.8; OR 5.3, 95% CI: 4.2-6.8). Of the ambulance presentations, 90% were admitted or received ongoing care.
Conclusions: COPD places considerable burden on the emergency healthcare pathway including ambulances and EDs in Queensland. Patients with COPD most commonly present to the ED by ambulance and receive extensive pre-hospital management. These patients have significant comorbidity burden and experience high rates of admission and mortality. More research is required to investigate the emergency pathway to further identify reversible factors and enhance healthcare practice and policy for COPD management.
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-328/coif). IAY serves as an unpaid editorial board member of Journal of Thoracic Disease. KMF serves as an unpaid Associate Editor-in-Chief of Journal of Thoracic Disease from February 2021 to January 2023. The other authors have no conflicts of interest to declare.
(2022 Journal of Thoracic Disease. All rights reserved.)
Databáze: MEDLINE