TY - JOUR
T1 - Management of acute exacerbations of COPD in the emergency department and its associations with clinical variables
AU - Freund, Ophir
AU - Melloul, Ariel
AU - Fried, Sabrina
AU - Kleinhendler, Eyal
AU - Unterman, Avraham
AU - Gershman, Evgeni
AU - Elis, Avishay
AU - Bar-Shai, Amir
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause for emergency department (ED) visits. Still, large scale studies that assess the management of AECOPD in the ED are limited. Our aim was to evaluate treatment characteristics of AE-COPD in the ED on a national scale. A prospective study as part of the COPD Israeli survey, conducted between 2017 and 2019, in 13 medical centers. Patients hospitalized with AECOPD were included and interviewed. Clinical data related to their ED and hospital stay were collected. 344 patients were included, 38% females, mean age of 70 ± 11 years. Median (IQR) time to first ED treatment was 59 (23–125) minutes and to admission 293 (173–490) minutes. Delayed ED treatment (> 1 h) was associated with older age (p = 0.01) and lack of a coded diagnosis of COPD in hospital records (p = 0.01). Long ED length-of-stay (> 5 h) was linked with longer hospitalizations (p = 0.01). Routine ED care included inhalations of short-acting bronchodilators (246 patients, 72%) and systemic steroids (188 patients, 55%). Receiving routine ED care was associated with its continuation during hospitalization (p < 0.001). In multivariate analysis, predictors for patients not receiving routine care were obesity (adjusted odds ratio 0.5, 95% CI 0.3–0.8, p = 0.01) and fever (AOR 0.3, 95% CI 0.1–0.6, p < 0.01), while oxygen saturation < 91% was an independent predictor for ED routine treatment (AOR 3.6, 95% CI 2.1–6.3, p < 0.01). Our findings highlight gaps in the treatment of AECOPD in the ED on a national scale, with specific predictors for their occurrence.
AB - Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause for emergency department (ED) visits. Still, large scale studies that assess the management of AECOPD in the ED are limited. Our aim was to evaluate treatment characteristics of AE-COPD in the ED on a national scale. A prospective study as part of the COPD Israeli survey, conducted between 2017 and 2019, in 13 medical centers. Patients hospitalized with AECOPD were included and interviewed. Clinical data related to their ED and hospital stay were collected. 344 patients were included, 38% females, mean age of 70 ± 11 years. Median (IQR) time to first ED treatment was 59 (23–125) minutes and to admission 293 (173–490) minutes. Delayed ED treatment (> 1 h) was associated with older age (p = 0.01) and lack of a coded diagnosis of COPD in hospital records (p = 0.01). Long ED length-of-stay (> 5 h) was linked with longer hospitalizations (p = 0.01). Routine ED care included inhalations of short-acting bronchodilators (246 patients, 72%) and systemic steroids (188 patients, 55%). Receiving routine ED care was associated with its continuation during hospitalization (p < 0.001). In multivariate analysis, predictors for patients not receiving routine care were obesity (adjusted odds ratio 0.5, 95% CI 0.3–0.8, p = 0.01) and fever (AOR 0.3, 95% CI 0.1–0.6, p < 0.01), while oxygen saturation < 91% was an independent predictor for ED routine treatment (AOR 3.6, 95% CI 2.1–6.3, p < 0.01). Our findings highlight gaps in the treatment of AECOPD in the ED on a national scale, with specific predictors for their occurrence.
KW - Chronic obstructive pulmonary disease
KW - Diagnosis
KW - Hospitalization
KW - Short-acting bronchodilators
KW - Steroids
UR - http://www.scopus.com/inward/record.url?scp=85190301929&partnerID=8YFLogxK
U2 - 10.1007/s11739-024-03592-w
DO - 10.1007/s11739-024-03592-w
M3 - Article
C2 - 38602629
AN - SCOPUS:85190301929
SN - 1828-0447
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
ER -