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

Journal of Thoracic Disease

article

Emily Sneath¹  Vivienne Tippett³  Rayleen V. Bowman¹  Kwun M. Fong¹  Wayne Hazell¹  Philip J. Masel¹  Denise Bunting⁵  Kerrianne Watt⁵  Ian A. Yang¹ 

[1] Faculty of Medicine, The University of Queensland;Department of Emergency Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service;School of Clinical Sciences, Queensland University of Technology;Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service;Information Support, Research & Evaluation

关键词: Chronic obstructive pulmonary disease (COPD);    exacerbation;    pre-hospital;    ambulance;    emergency department (ED);   

DOI  :  10.21037/jtd-22-328

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

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: 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.

【 授权许可】

Unknown