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Raeisy L, Masoompour SM, Rezaianzadeh A. Evaluation of the prevalence of asthma and chronic obstructive pulmonary disease among opium users, and cigarette smokers and comparison with normal population in Kharameh: a cross-sectional study. BMC Pulm Med 2023; 23:419. [PMID: 37914995 PMCID: PMC10619218 DOI: 10.1186/s12890-023-02734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Recent studies have suggested that opium use may increase mortality from pulmonary diseases. However, there are limited comprehensive studies regarding the prevalence of Asthma and Chronic Obstructive Pulmonary Disease (COPD) among tobacco and opium users has been published. We aimed to determine the prevalence of respiratory disease among tobacco and opium users. METHODS This cross-sectional study of tobacco and opium users and matched controls was conducted in the Kharameh Cohort, Fars, Iran. The prevalence of COPD and asthma, along with the participants demographical and spirometry data were examined. RESULTS The average age of participants was 57 ± 8 years. Never smokers had a significant higher BMI (26.6 vs. 24.8), FEV1 (91% vs. 82%) and FVC (96% vs. 88%) values compared to participants with a positive smoking status. There was a statistical difference in the prevalence of COPD, asthma, and asthma COPD overlap (ACO) based on the participants smoking status, with the highest prevalence among opium and cigarette smokers, followed by opium users alone. Based on multivariate analysis, higher age, lower BMI, lower education than under diploma, cigarette smoking and opium use were significantly correlated with higher COPD prevalence; while lower age, cigarette smoking and opium use were significantly correlated with higher asthma prevalence. Illiterate participants had a significantly higher prevalence of COPD (23.6%), asthma (22%), and ACO (7.9%) among the educational groups. Regarding the prevalence of asthma, the higher socio-economic group had the lowest prevalence. CONCLUSIONS Opium and tobacco users had a significantly higher prevalence of respiratory diseases, along with lower lung function tests based on spirometry evaluation.
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Affiliation(s)
- Laleh Raeisy
- Student Research committee of medical school, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Masoom Masoompour
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Barbosa J, Organista D, Rodrigues T, Matos AF, Barardo A, Escoval A, Bárbara C, Rodrigues F. Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality. Pulmonology 2023:S2531-0437(23)00012-0. [PMID: 36797150 DOI: 10.1016/j.pulmoe.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as "non-urgent" or "avoidable." The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality. MATERIALS AND METHODS A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed. RESULTS Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as "urgent/very urgent." A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777-87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis. CONCLUSIONS Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.
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Affiliation(s)
- J Barbosa
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal.
| | - D Organista
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - T Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A F Matos
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Barardo
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Escoval
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Center for Research in Public Health (CISP), Center for Integrated Research in Health - Research, Education, and Innovation in Clinical Research and Public Health (CHRC), Escola Nacional de Saúde Pública, Av. Padre Cruz, 1600-560 Lisbon, Portugal
| | - C Bárbara
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
| | - F Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
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Almuntashiri S, Jones TW, Wang X, Sikora A, Zhang D. Plasma TIMP-1 as a sex-specific biomarker for acute lung injury. Biol Sex Differ 2022; 13:70. [PMID: 36482481 PMCID: PMC9733313 DOI: 10.1186/s13293-022-00481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) confers high morbidity and mortality, with a death rate reaching 40%. Pre-clinical and clinical studies have cited sex-specific sex hormones as a critical contributor to divergent immunologic responses. Therefore, exploration of sex and sex hormone roles following lung injury and ARDS development is needed. Tissue inhibitor of metalloproteinase-1 (TIMP-1) was the first-discovered natural collagenase inhibitor and is located exclusively on the X chromosome. This study aimed to evaluate the prognostic role of circulating TIMP-1, and if concentration differences between males and females correlate with the mortality of ARDS patients. METHODS Human plasma samples from 100 ARDS patients enrolled in Albuterol to Treat Acute Lung Injury (ALTA) trial on the day of randomization were evaluated. The amount of TIMP-1 was measured using an enzyme-linked immunoassay (ELISA). Area under the receiver operating characteristic (AUROC) was computed to assess the predictive power of TIMP-1 for 30 and 90-day mortality. Chi-squared tests and Kaplan-Meier curves were computed to assess different variables and survival. RESULTS AUROC analysis of TIMP-1 and 30-day mortality among females showed that TIMP-1 exhibited an AUC of 0.87 (95% confidence interval [CI] 0.78 to 0.97; P = 0.0014) with an optimal cut-off value of 159.7 ng/mL producing a 100% sensitivity and 74% specificity. For 90-day mortality, AUROC analysis showed an AUC of 0.82 (95% confidence interval [CI] 0.67 to 0.97; P = 0.0016) with a similar cut-off value producing a 90% sensitivity and 76.47% specificity. Stratifying subjects by TIMP-1 concentration as high (≥ 159.7 ng/mL) or low (< 159.7 ng/mL) indicated that high TIMP-1 was associated with increased 30 and 90-day mortality rates (all P < 0.0001). Lastly, high TIMP-1 group was associated with worse other outcomes including ventilator-free days (VFDs) and ICU-free days (all P < 0.05). CONCLUSION Circulating TIMP-1 appeared to be a promising biomarker for mortality among females with ARDS. The high TIMP-1 group showed worse VFDs and ICU-free days. Circulating TIMP-1 may be a sex-specific biomarker in the setting of ARDS and could improve ARDS phenotyping as well as provide a novel therapeutic target in females.
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Affiliation(s)
- Sultan Almuntashiri
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, 30912, USA.,Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, 55473, Saudi Arabia
| | - Timothy W Jones
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, 30912, USA
| | - Xiaoyun Wang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, 30912, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, 30901, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, 30912, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, 30912, USA. .,Department of Medicine, Augusta University, Augusta, GA, 30912, USA.
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Evaluation of Hospital Admission Status for Emergency Department Patients Seen for Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Observational Study. Ochsner J 2021; 21:19-24. [PMID: 33828422 PMCID: PMC7993420 DOI: 10.31486/toj.19.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a common and preventable condition. The disease accounts for a large economic burden in the US health care system. Better control and prevention of COPD exacerbations can help prevent presentations to already-crowded emergency departments (EDs) and hospitals. The objective of our study was to identify variables associated with hospital admission status in ED patients presenting with COPD exacerbation. Methods: We conducted a retrospective observational study of patients seen at 1 of 3 US EDs from 2012 to 2014 with a primary diagnosis related to COPD exacerbation. Hospital admission status was modeled using patient characteristic data via adaptive least absolute shrinkage and selection operator logistic regression. Study results are presented as adjusted odds ratios with 95% CIs. Planned post hoc model dependency and external data sensitivity analyses were conducted. Results: The study sample included 1,165 unique patients with COPD with an ED encounter related to exacerbation at 1 of the 3 reviewed hospitals. Approximately half of these patients had a hospital admission. Variables inversely associated with an admission included oxygen saturation and number of prior ED encounters for COPD exacerbation. Variables positively associated with admission were initial ED heart rate, patient age, and documented comorbidities of anxiety and/or depression. These mental health comorbidities had the strongest association with admission status. Conclusion: Understanding the characteristics of admitted patients may help direct resources and outpatient services to prevent encounters. Of note, the study revealed mental health variables as being strongly associated with admission status.
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sorge R, DeBlieux P. Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians. J Emerg Med 2020; 59:643-659. [PMID: 32917442 DOI: 10.1016/j.jemermed.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. OBJECTIVE To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. DISCUSSION Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based on the intensity of symptoms, presence of comorbidities, severity of the disease, and response to therapy. Patients who are appropriate for discharge from the ED should be prescribed evidence-based treatments and smoking cessation to prevent disease progression. A patient-centric discharge care plan should include medication reconciliation; bedside "teach-back," wherein patients demonstrate proper inhaler usage; and prompt follow-up. CONCLUSIONS An effective assessment, accurate diagnosis, and appropriate discharge plan for patients with AECOPD could improve treatment outcomes, reduce hospitalization, and decrease unplanned repeat visits to the ED.
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Affiliation(s)
- Randy Sorge
- Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Sciences Center, University Medical Center, New Orleans, Louisiana
| | - Peter DeBlieux
- Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Sciences Center, University Medical Center, New Orleans, Louisiana
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Kocak AO, Cakir Z, Akbas I, Gur STA, Kose MZ, Can NO, Sengun E, Gemis OF. Comparison of two scores of short term serious outcome in COPD patients. Am J Emerg Med 2020; 38:1086-1091. [DOI: 10.1016/j.ajem.2019.158376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
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Stiell IG, Perry JJ, Clement CM, Brison RJ, Rowe BH, Aaron SD, McRae AD, Borgundvaag B, Calder LA, Forster AJ, Brinkhurst J, Wells GA. Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department. CMAJ 2019; 190:E1406-E1413. [PMID: 30510045 DOI: 10.1503/cmaj.180232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Ottawa chronic obstructive pulmonary disease (COPD) Risk Scale (OCRS), which consists of 10 criteria, was previously derived to identify patients in the emergency department with COPD who were at high risk for short-term serious outcomes. We sought to validate, prospectively and explicitly, the OCRS when applied by physicians in the emergency department. METHODS We conducted this prospective cohort study involving patients in the emergency departments at 6 tertiary care hospitals and enrolled adults with acute exacerbation of COPD from May 2011 to December 2013. Physicians evaluated patients for the OCRS criteria, which were recorded on a data form along with the total risk score. We followed patients for 30 days and the primary outcome, short-term serious outcomes, was defined as any of death, admission to monitored unit, intubation, noninvasive ventilation, myocardial infarction (MI) or relapse with hospital admission. RESULTS We enrolled 1415 patients with a mean age of 70.6 (SD 10.6) years and 50.2% were female. Short-term serious outcomes occurred in 135 (9.5%) cases. Incidence of short-term serious outcomes ranged from 4.6% for a total score of 0 to 100% for a score of 10. Compared with current practice, an OCRS score threshold of greater than 1 would increase sensitivity for short-term serious outcomes from 51.9% to 79.3% and increase admissions from 45.0% to 56.6%. A threshold of greater than 2 would improve sensitivity to 71.9% with 47.9% of patients being admitted. INTERPRETATION In this clinical validation of a risk-stratification tool for COPD in the emergency department, we found that OCRS showed better sensitivity for short-term serious outcomes compared with current practice. This risk scale can now be used to help emergency department disposition decisions for patients with COPD, which should lead to a decrease in unnecessary admissions and in unsafe discharges.
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Affiliation(s)
- Ian G Stiell
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta.
| | - Jeffrey J Perry
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Catherine M Clement
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Robert J Brison
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Brian H Rowe
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Shawn D Aaron
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Andrew D McRae
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Bjug Borgundvaag
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Lisa A Calder
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Alan J Forster
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - Jennifer Brinkhurst
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
| | - George A Wells
- Departments of Emergency Medicine (Stiell, Calder, Perry) and Medicine (Aaron, Forster), Clinical Epidemiology Program, Ottawa Hospital Research Institute (Stiell, Perry, Clement, Aaron, Forster, Brinkhurst), University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Division of Emergency Medicine, Department of Family and Community Medicine (Borgundvaag), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Brison), Kingston Health Sciences Centre, Kingston, Ont.; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Department of Emergency Medicine and School of Public Health, University of Alberta, and Alberta Health Services (Rowe), Edmonton, Alta
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Kraaijvanger N, Rijpsma D, Roovers L, van Leeuwen H, Kaasjager K, van den Brand L, Horstink L, Edwards M. Development and validation of an admission prediction tool for emergency departments in the Netherlands. Emerg Med J 2018; 35:464-470. [DOI: 10.1136/emermed-2017-206673] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/22/2018] [Accepted: 03/18/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveEarly prediction of admission has the potential to reduce length of stay in the ED. The aim of this study is to create a computerised tool to predict admission probability.MethodsThe prediction rule was derived from data on all patients who visited the ED of the Rijnstate Hospital over two random weeks. Performing a multivariate logistic regression analysis factors associated with hospitalisation were explored. Using these data, a model was developed to predict admission probability. Prospective validation was performed at Rijnstate Hospital and in two regional hospitals with different baseline admission rates. The model was converted into a computerised tool that reported the admission probability for any patient at the time of triage.ResultsData from 1261 visits were included in the derivation of the rule. Four contributing factors for admission that could be determined at triage were identified: age, triage category, arrival mode and main symptom. Prospective validation showed that this model reliably predicts hospital admission in two community hospitals (area under the curve (AUC) 0.87, 95% CI 0.85 to 0.89) and in an academic hospital (AUC 0.76, 95% CI 0.72 to 0.80). In the community hospitals, using a cut-off of 80% for admission probability resulted in the highest number of true positives (actual admissions) with the greatest specificity (positive predictive value (PPV): 89.6, 95% CI 84.5 to 93.6; negative predictive value (NPV): 70.3, 95% CI 67.6 to 72.9). For the academic hospital, with a higher admission rate, a 90% probability was a better cut-off (PPV: 83.0, 95% CI 73.8 to 90.0; NPV: 59.3, 95% CI 54.2 to 64.2).ConclusionAdmission probability for ED patients can be calculated using a prediction tool. Further research must show whether using this tool can improve patient flow in the ED.
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Singh JA, Yu S. Utilization due to chronic obstructive pulmonary disease and its predictors: a study using the U.S. National Emergency Department Sample (NEDS). Respir Res 2016; 17:1. [PMID: 26739476 PMCID: PMC4702346 DOI: 10.1186/s12931-015-0319-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022] Open
Abstract
Background Previous studies of healthcare utilization for chronic obstructive pulmonary disease (COPD) have focused on time-trends in COPD visits or COPD treatments, or the effect of hospital volume on mortality. Few data are available regarding outcomes after an ED visit (and subsequent hospitalization) for COPD, which are both very common in patients with COPD. Our objective was to assess time-trends and predictors of emergency department and subsequent inpatient health care utilization and charges associated with COPD in the U.S. Method We used the 2009-12 U.S. Nationwide Emergency Department Sample (NEDS) to study the incidence of ED visits and subsequent hospitalizations with COPD as the primary diagnosis. We used the 2012 NEDS data to study key patient/hospital factors associated with outcomes, including charges, hospitalization and dischage from hospital to home. Results ED visits for COPD as the primary diagnosis increased from 1.02 million in 2009 to 1.04 in 2010 to 1.10 million in 2012 (0.79–0.82 % of all ED visits); respective charges were $2.13, $2.32, and $3.09 billion. In 2012, mean ED charges/visit were $2,812, hospitalization charges/visit were $29,043 and the length of hospital stay was 4.3 days. 49 % were hospitalized after an ED visit. Older age, higher median income, metropolitan residence and comorbidities (diabetes, hypertension, HF, hyperlipidemia, CHD, renal failure and osteoarthritis) were associated with higher risk whereas male sex, Medicaid or self pay insurance status, hospital location in Midwest, South or West U.S. were associated with lower risk of hospitalization. 65.4 % of all patients hospitalized for COPD from ED were discharged home. Older age, comorbidities (diabetes, HF, CHD, renal failure, osteoarthritis) and metropolitan residence were associated with lower odds of discharge to home, whereas male sex, payer other than Medicare, Midwest, South or West U.S. hospital location were associated with higher odds. Conclusion Health care utilization and costs in patients with COPD are significant and increasing. COPD constitutes a major public health burden in the U.S. We identified risk factors for hospitalization, costs, and home discharge in patients with COPD that will allow future studies to investigate interventions to potentially reduce COPD-associated utilization. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0319-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Shaohua Yu
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
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Wheaton AG, Ford ES, Cunningham TJ, Croft JB. Chronic obstructive pulmonary disease, hospital visits, and comorbidities: National Survey of Residential Care Facilities, 2010. J Aging Health 2014; 27:480-99. [PMID: 25288588 DOI: 10.1177/0898264314552419] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the prevalence of chronic obstructive pulmonary disease (COPD) among residential care facility (RCF) residents in the United States, and to compare patterns of hospital visits and comorbidities with residents without COPD. METHOD Resident data from the 2010 National Survey of Residential Care Facilities were analyzed. Medical history and information on past-year hospital visits for 8,089 adult residents were obtained from interviews with RCF staff. RESULTS COPD prevalence was 12.4%. Compared with residents without COPD, emergency department visits or overnight hospital stays in the previous year were more prevalent (p < .05) among residents with COPD. Less than 3% of residents with COPD had no comorbidities. Arthritis, depression, congestive heart failure (CHF), diabetes, coronary heart disease, and asthma were more common (p < .05) among residents with COPD than those without COPD, but Alzheimer's disease was less common. DISCUSSION COPD is associated with more emergency department visits, hospital stays, and comorbidities among RCF residents.
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Affiliation(s)
- Anne G Wheaton
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Earl S Ford
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Janet B Croft
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hahn EJ, Rayens MK, Adkins S, Simpson N, Frazier S, Mannino DM. Fewer hospitalizations for chronic obstructive pulmonary disease in communities with smoke-free public policies. Am J Public Health 2014; 104:1059-65. [PMID: 24825207 DOI: 10.2105/ajph.2014.301887] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). METHODS We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. RESULTS Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban-rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate-weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. CONCLUSIONS Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs.
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Affiliation(s)
- Ellen J Hahn
- Ellen J. Hahn, Mary Kay Rayens, and Nick Simpson are with the Tobacco Policy Research Program, University of Kentucky College of Nursing and College of Public Health, Lexington. Sarah Adkins and Susan Frazier are with the University of Kentucky College of Nursing. Susan Frazier is also with the RICH Heart Program, University of Kentucky College of Nursing. David M. Mannino is with the Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health
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Stiell IG, Clement CM, Aaron SD, Rowe BH, Perry JJ, Brison RJ, Calder LA, Lang E, Borgundvaag B, Forster AJ, Wells GA. Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. CMAJ 2014; 186:E193-204. [PMID: 24549125 PMCID: PMC3971051 DOI: 10.1503/cmaj.130968] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To assist physicians with difficult decisions about hospital admission for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) presenting in the emergency department, we sought to identify clinical characteristics associated with serious adverse events. METHODS We conducted this prospective cohort study in 6 large Canadian academic emergency departments. Patients were assessed for standardized clinical variables and then followed for serious adverse events, defined as death, intubation, admission to a monitored unit or new visit to the emergency department requiring admission. RESULTS We enrolled 945 patients, of whom 354 (37.5%) were admitted to hospital. Of 74 (7.8%) patients with a subsequent serious adverse event, 36 (49%) had not been admitted after the initial emergency visit. Multivariable modelling identified 5 variables that were independently associated with adverse events: prior intubation, initial heart rate ≥ 110/minute, being too ill to do a walk test, hemoglobin < 100 g/L and urea ≥ 12 mmol/L. A preliminary risk scale incorporating these and 5 other clinical variables produced risk categories ranging from 2.2% for a score of 0 to 91.4% for a score of 10. Using a risk score of 2 or higher as a threshold for admission would capture all patients with a predicted risk of adverse events of 7.2% or higher, while only slightly increasing admission rates, from 37.5% to 43.2%. INTERPRETATION In Canada, many patients with COPD suffer a serious adverse event or death after being discharged home from the emergency department. We identified high-risk characteristics and developed a preliminary risk scale that, once validated, could be used to stratify the likelihood of poor outcomes and to enable rational and safe admission decisions.
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Affiliation(s)
- Ian G. Stiell
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Catherine M. Clement
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Shawn D. Aaron
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Brian H. Rowe
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Jeffrey J. Perry
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Robert J. Brison
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Lisa A. Calder
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Eddy Lang
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Bjug Borgundvaag
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - Alan J. Forster
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
| | - George A. Wells
- Department of Emergency Medicine (Stiell, Perry, Calder), Department of Medicine (Aaron, Forster) and University of Ottawa Heart Institute (Wells), University of Ottawa, Ottawa, Ont.; Clinical Epidemiology Program (Clement), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Emergency Medicine (Rowe), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (Brison), Queen’s University, Kingston, Ont.; Division of Emergency Medicine (Lang), University of Calgary, Calgary, Alta.; Division of Emergency Medicine (Borgundvaag), University of Toronto, Toronto, Ont
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Yeatts KB, Lippmann SJ, Waller AE, Hassmiller Lich K, Travers D, Weinberger M, Donohue JF. Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks. Chest 2014; 144:784-793. [PMID: 23579283 DOI: 10.1378/chest.12-1899] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Little is known about the population-based burden of ED care for COPD. METHODS We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities. RESULTS In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. CONCLUSIONS The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.
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Affiliation(s)
- Karin B Yeatts
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill; Gillings School of Global Public Health, Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill.
| | - Steven J Lippmann
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill; Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Anna E Waller
- Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill
| | - Debbie Travers
- Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill; School of Medicine, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC
| | - James F Donohue
- Department of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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García-Sanz MT, Pol-Balado C, Abellás C, Cánive-Gómez JC, Antón-Sanmartin D, González-Barcala FJ. Factors associated with hospital admission in patients reaching the emergency department with COPD exacerbation. Multidiscip Respir Med 2012; 7:6. [PMID: 22958396 PMCID: PMC3436640 DOI: 10.1186/2049-6958-7-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the frequency of COPD exacerbations in our Emergency Department, as well as the hospitalization-related factors. METHODS Prospective observational study conducted in the Emergency Department of Salnés County Hospital among patients admitted for COPD exacerbation. Admission predictors were determined by multivariate analysis. RESULTS There were 409 exacerbations in 239 patients (79% male, mean age 75). 57% of exacerbations required hospitalization. Hospitalization-related factors were impaired oxygenation (p < 0.001), presence of neutrophilia (p < 0.01) and prescription of antibiotics in the Emergency Department (p < 0.05). CONCLUSIONS COPD exacerbation accounts for over 1% of all visits to our Emergency Department. 57% of them required hospitalization. Impaired oxygenation, greater neutrophilia and prescription of antibiotics in the Emergency Department were associated with greater probability of admission.
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Affiliation(s)
- Maria Teresa García-Sanz
- Emergency Department, Salnés County Hospital, Ande-Rubiáns s/n, Vilagarcía de Arousa, Pontevedra, Spain
| | - Carlos Pol-Balado
- Emergency Department, Salnés County Hospital, Ande-Rubiáns s/n, Vilagarcía de Arousa, Pontevedra, Spain
| | - Concepción Abellás
- Emergency Department, Salnés County Hospital, Ande-Rubiáns s/n, Vilagarcía de Arousa, Pontevedra, Spain
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Gender and acute respiratory distress syndrome in critically injured adults: a prospective study. ACTA ACUST UNITED AC 2011; 71:878-83; discussion 883-5. [PMID: 21986736 DOI: 10.1097/ta.0b013e31822c0d31] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The acute respiratory distress syndrome (ARDS) is a proinflammatory condition that often complicates trauma and critical illness. Animal studies have shown that both gender and sex hormones play an important role in inflammatory regulation. Human data are scant regarding the role of gender and sex hormones in developing ARDS. Our objective was to describe gender and hormonal differences in patients who develop ARDS in a large cohort of critically injured adults. METHODS A prospective cohort study of adult trauma patients requiring intensive care unit admission for at least 48 hours was performed. Demographic and clinical data were collected prospectively, and sex hormones were assayed at study entry (48 hours). The primary outcome was the development of ARDS. Multivariate logistic regression was used to determine the adjusted odds of death associated with differences in gender. RESULTS Six hundred forty-eight patients met entry criteria, and 180 patients developed ARDS (31%). Women were more likely to develop ARDS (35% vs. 25%, p=0.02). This association remained after adjusting for age, mechanism of injury, injury severity, and blood product transfusion (odds ratio, 1.6; 95% confidence interval: 1.1-2.4; p=0.02). Of patients with ARDS, there was no difference in mortality related to gender (22% mortality in women with ARDS vs. 20% in men; p=not significant). A proinflammatory sex hormone profile (low testosterone and high estradiol) was associated with ARDS in both men and women. CONCLUSION Women are more likely than men to develop ARDS after critical injury. Despite the increased incidence in ARDS, the mortality in patients with ARDS does not differ according to gender. The inflammatory properties of sex hormones may contribute to ARDS, but they do not fully explain observed gender differences.
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Rowe BH, Voaklander DC, Marrie TJ, Senthilselvan A, Klassen TP, Rosychuk RJ. Outcomes following chronic obstructive pulmonary disease presentations to emergency departments in Alberta: a population-based study. Can Respir J 2010; 17:295-300. [PMID: 21165352 PMCID: PMC3006153 DOI: 10.1155/2010/924978] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a complex, multisystem disorder that often results in exacerbations requiring emergency department (ED) management. Following an exacerbation and discharge from the ED, reassessment and management adjustment with a health care provider are recommended to re-establish control of the disease. OBJECTIVES To describe outcomes of all COPD presentations to EDs made by adults in Alberta including the time spent in the ED and the physician visits following the ED visit. METHODS Provincial administrative databases were used to obtain all ED encounters for COPD during six fiscal years (1999 to 2005). The information extracted included demographics, ED visit timing, and acute and subacute outcomes (physician visits up to 365 days after discharge for all 7302 discharged individuals during a one-year period). Data analysis included descriptive summaries and survival curves. RESULTS There were 85,330 ED visits for acute COPD, of which 67% were discharged from the ED. Median ED length of stay was longer in large urban areas (Calgary: 5 h 9 min; Edmonton: 4 h 58 min) than in other regions of Alberta (1 h 17 min). Admissions resulted from 32% of visits and varied among regions; however, few were admitted to the intensive care unit (1%) or died (0.1%). Following discharge, the median time to first follow-up with a physician was 13 days; however, only 40% of patients had follow-up visits in the first seven days. Repeat ED visits within seven days occurred in 5.7% of discharged patients, while 25.6% of discharged patients had repeat ED visits within 365 days of discharge. CONCLUSIONS More than 30% of COPD ED visits resulted in admission; regional variation was significant. Moreover, discharged patients experienced delayed follow-up and often required repeat ED visits. Interventions to improve reassessment and reduce COPD-related repeat ED visits should be explored.
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Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine
- School of Public Health, University of Alberta, Edmonton, Alberta
| | | | - Thomas J Marrie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | | | - Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba
- Manitoba Institute of Child Health, Winnipeg, Manitoba
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta
- Women and Children’s Health Research Institute, Edmonton, Alberta
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Zhang Y, Niu J, Felson DT, Choi HK, Nevitt M, Neogi T. Methodologic challenges in studying risk factors for progression of knee osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62:1527-32. [PMID: 20617531 DOI: 10.1002/acr.20287] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/28/2010] [Indexed: 11/07/2022]
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Einarsdóttir K, Preen DB, Sanfilippo FM, Reeve R, Emery JD, Holman CDJ. Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study. BMC Public Health 2010; 10:385. [PMID: 20591200 PMCID: PMC2910678 DOI: 10.1186/1471-2458-10-385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 07/01/2010] [Indexed: 11/10/2022] Open
Abstract
Background Relatively few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. This study aimed to investigate these issues in older (≥ 65) CRD patients in Western Australia. Methods We identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim. Results Patients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003). Conclusions Older patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.
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Affiliation(s)
- Kristjana Einarsdóttir
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, 6009 Perth, Australia.
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Rowe BH, Villa-Roel C, Guttman A, Ross S, Mackey D, Sivilotti MLA, Worster A, Stiell IG, Willis V, Borgundvaag B. Predictors of hospital admission for chronic obstructive pulmonary disease exacerbations in Canadian emergency departments. Acad Emerg Med 2009; 16:316-24. [PMID: 19298621 DOI: 10.1111/j.1553-2712.2009.00366.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to examine predictors of hospital admission among adults presenting to Canadian emergency departments (EDs) for acute exacerbations of chronic obstructive pulmonary disease (COPD). Current acute treatment approaches and outcomes 2 weeks after the ED visit are also described. METHODS Subjects, aged > or =35 years presenting with COPD exacerbations to 16 EDs across Canada, underwent a structured in-ED interview and a telephone interview 2 weeks later. RESULTS Of 501 study patients, 247 (49.3%; 95% confidence interval [CI] = 44.9% to 53.6%) were admitted. Admitted patients were older, were more often former smokers, and had more admissions for COPD during the past 2 years. They also reported more days of activity limitation and use of inhaled beta(2)-agonists in the previous 24 hours. Canadian Triage and Acuity Scale (CTAS), respiratory rate (RR), and airflow obstruction were more severe in the hospitalized group. Most of the patients received inhaled beta(2)-agonists, anticholinergics, oral corticosteroids (CS), and antibiotics; hospitalized patients received more aggressive treatments. The median ED length of stay (LOS) of admitted patients was 13.1 hours (interquartile range [IQR] = 7.4-23.0) compared to 5.6 hours (IQR = 4.2-8.4) in discharged patients. Admission was associated with at least two COPD admissions in the past 2 years (odds ratio [OR] = 2.10; 95% CI = 1.24 to 3.56), receiving oral CS for COPD (OR = 1.72; 95% CI = 1.08 to 2.74), having a CTAS score of 1-2 (OR = 2.04; 95% CI = 1.33 to 3.12), and receiving adjunct ED treatments (OR = 3.95; 95% CI = 2.45 to 6.35). Use of EDs for usual COPD care was associated with a reduced risk of admission (OR = 0.43; 95% CI = 0.28 to 0.66). CONCLUSIONS Exacerbations of COPD in Canadian EDs result in prolonged ED stays and approximately 50% hospitalization despite aggressive acute treatment approaches. Historical, severity, and treatment-related factors were strongly associated with hospital admission. Validation of these results should be completed prior to widespread use.
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Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Tsai CL, Camargo CA. Racial and ethnic differences in emergency care for acute exacerbation of chronic obstructive pulmonary disease. Acad Emerg Med 2009; 16:108-15. [PMID: 19076100 DOI: 10.1111/j.1553-2712.2008.00319.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective was to investigate racial and ethnic differences in emergency care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). METHODS The authors performed a prospective multicenter cohort study involving 24 emergency departments (EDs) in 15 U.S. states. Using a standard protocol, consecutive ED patients with AECOPD were interviewed, their charts reviewed, and 2-week telephone follow-ups were completed. RESULTS Among 330 patients, 218 (66%) were white, 84 (25%) were African American, and 28 (8%) were Hispanic. A quarter of the 24 EDs cared for 59% of all minority patients. Compared with white patients, African American and Hispanic patients were more likely to be uninsured or with Medicaid (19, 49, and 52%, respectively; p < 0.001), were less likely to have a primary care provider (93, 81, and 82%, respectively; p = 0.005), and had more frequent ED visits in the past year (medians = 1, 2, and 3, respectively; p = 0.002). In the unadjusted analyses, minority patients were less likely to receive diagnostic procedures, more likely to receive systemic corticosteroids in the ED, less likely to be admitted, and more likely to have a relapse. After adjustment for patient and ED characteristics, these many racial and ethnic differences in quality of care were nearly completely eliminated. CONCLUSIONS Despite pronounced racial and ethnic differences in stable COPD, all racial and ethnic groups received comparable quality of emergency care for AECOPD and had similar short-term outcomes.
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Affiliation(s)
- Chu-Lin Tsai
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Rowe BH, Cydulka RK, Tsai CL, Clark S, Sinclair D, Camargo CA. Comparison of Canadian versus United States emergency department visits for chronic obstructive pulmonary disease exacerbation. Can Respir J 2008; 15:295-301. [PMID: 18818783 PMCID: PMC2679560 DOI: 10.1155/2008/696482] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the frequency of emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation, little is known about practice variation in EDs. OBJECTIVES To examine the differences between Canadian and United States (US) COPD patients, and the ED management they receive. METHODS A prospective multicentre cohort study was conducted involving 29 EDs in the US and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbations were interviewed, their charts reviewed and a two-week telephone follow-up completed. Comparisons between Canadian and US patients, as well as their treatment and outcomes, were made. Predictors of antibiotic use were determined by multivariate logistic regression. RESULTS Of 584 patients who had physician-diagnosed COPD, 397 (68%) were enrolled. Of these, 63 patients (16%) were from Canada. Canadians were older (73 years versus 69 years; P=0.002), more often white (97% versus 65%; P<0.001), less educated (P=0.003) and more commonly insured (P<0.001) than the US patients. US patients more commonly used the ED for their usual COPD medications (17% versus 3%; P=0.005). Although Canadian patients had fewer pack-years of smoking (45 pack-years versus 53 pack-years; P=0.001), current COPD medications and comorbidities were similar. At ED presentation, Canadian patients were more often hypoxic and symptomatic. ED treatment with inhaled beta-agonists (approximately 90%) and systemic corticosteroids (approximately 65%) were similar; Canadians received more antibiotics (46% versus 25%; P<0.001) and other treatments (29% versus 11%; P=0.002). Admission rates were similar in both countries (approximately 65%), although Canadian patients remained in the ED longer than the US patients (10 h versus 5 h, respectively; P<0.001). CONCLUSIONS Overall, patients with acute COPD in Canada and the US appear to have similar history, ED treatment and outcomes; however, Canadian patients are older and receive more aggressive treatment in the ED. In both countries, the prolonged length of stay and high admission rate contribute to the ED overcrowding crisis facing EDs.
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Affiliation(s)
- B H Rowe
- Dept of Emergency Medicine, University of Alberta, Edmonton, Canada.
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Tsai CL, Griswold SK, Clark S, Camargo CA. Factors associated with frequency of emergency department visits for chronic obstructive pulmonary disease exacerbation. J Gen Intern Med 2007; 22:799-804. [PMID: 17410402 PMCID: PMC2219867 DOI: 10.1007/s11606-007-0191-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/06/2006] [Accepted: 03/23/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations. OBJECTIVE To characterize the use of emergency department (ED) services in patients with COPD exacerbation and identify factors associated with FEDV. DESIGN A prospective, multicenter cohort study. PATIENTS Three hundred eighty-eight patients were included. Fifty-two percent were women and the median age was 69 years (interquartile range 62-76). MEASUREMENTS Using a standard questionnaire, consecutive ED patients with COPD exacerbation were interviewed. The number of ED visits in the previous year was retrospectively collected. RESULTS Over the past year, this cohort reported a total of 1,090 ED visits because of COPD exacerbation. Thirteen percent of COPD patients had 6 or more ED visits, accounting for 57% of the total ED visits in the past year. Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.16-3.33), to have more severe COPD as determined by previous hospitalizations (IRR 2.06, 95% CI 1.51-2.82), prior intubations (IRR 1.49, 95% CI 1.02-2.18), prior use of systemic corticosteroids (IRR 1.57, 95% CI 1.16-2.13) and methylxanthine (IRR 1.48, 95% CI 1.04-2.12), and less likely to have a primary care provider (IRR 0.51, 95% CI 0.31-0.82). CONCLUSIONS Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.
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Affiliation(s)
- Chu-Lin Tsai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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