Anne Maree Kelly1,2, Anna Holdgate3,4, Gerben Keijzers5,6,7, Sharon Klim1, Colin A Graham8, Simon Craig9,10,11, Win Sen Kuan12,13, Peter Jones14, Charles Lawoko15, Said Laribi16. 1. Joseph Epstein Centre for Emergency Medicine, Sunshine Hospital, St Albans, VIC, Australia. 2. School of Medicine - Western Clinical School, The University of Melbourne, Melbourne, VIC, Australia. 3. Department of Emergency Medicine, Liverpool Hospital, Sydney, NSW, Australia. 4. University of New South Wales (Southwest Clinical School), Sydney, NSW, Australia. 5. Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia. 6. School of Medicine, Bond University, Gold Coast, QLD, Australia. 7. School of Medicine, Griffith University, Gold Coast, QLD, Australia. 8. Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong. 9. Emergency Department, Monash Medical Centre, Melbourne, VIC, Australia. 10. School of Clinical Sciences, Monash University, Melbourne, VIC, Australia. 11. Murdoch Children's Research Institute, Melbourne, VIC, Australia. 12. Emergency Medicine Department, National University Health System, Singapore. 13. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 14. Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand. 15. Industry Doctoral Training Centre, ATN Universities, Melbourne, VIC, Australia. 16. Emergency Medicine Department, Tours University Hospital, François-Rabelais University, Tours, France.
Abstract
BACKGROUND AND OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED. METHODS: This was a planned sub-study of patients with an ED diagnosis of AECOPD identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. The AANZDEM was a prospective, interrupted time series cohort study conducted in 46 ED in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72-h periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality). RESULTS: Forty-six ED participated. There were 415 patients with an ED primary diagnosis of AECOPD (13.6% of the overall cohort; 95% CI: 12.5-14.9%). Median age was 73 years, 60% males and 65% arrived by ambulance. Ninety-one percent had an existing COPD diagnosis. Eighty percent of patients received inhaled bronchodilators, 66% received systemic corticosteroids and 57% of those with pH < 7.30 were treated with non-invasive ventilation (NIV). Seventy-eight percent of patients were admitted to hospital, 7% to an intensive care unit. In-hospital mortality was 4% and median LOS was 4 days (95% CI: 2-7). CONCLUSION: Patients treated in ED for AECOPD commonly arrive by ambulance, have a high admission rate and significant in-hospital mortality. Compliance with evidence-based treatments in ED is suboptimal affording an opportunity to improve care and potentially outcomes.
BACKGROUND AND OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED. METHODS: This was a planned sub-study of patients with an ED diagnosis of AECOPD identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. The AANZDEM was a prospective, interrupted time series cohort study conducted in 46 ED in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72-h periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality). RESULTS: Forty-six ED participated. There were 415 patients with an ED primary diagnosis of AECOPD (13.6% of the overall cohort; 95% CI: 12.5-14.9%). Median age was 73 years, 60% males and 65% arrived by ambulance. Ninety-one percent had an existing COPD diagnosis. Eighty percent of patients received inhaled bronchodilators, 66% received systemic corticosteroids and 57% of those with pH < 7.30 were treated with non-invasive ventilation (NIV). Seventy-eight percent of patients were admitted to hospital, 7% to an intensive care unit. In-hospital mortality was 4% and median LOS was 4 days (95% CI: 2-7). CONCLUSION:Patients treated in ED for AECOPD commonly arrive by ambulance, have a high admission rate and significant in-hospital mortality. Compliance with evidence-based treatments in ED is suboptimal affording an opportunity to improve care and potentially outcomes.
Authors: Neha N Goel; Clark Owyang; Shamsuddoha Ranginwala; George T Loo; Lynne D Richardson; Kusum S Mathews Journal: Respir Care Date: 2019-10-01 Impact factor: 2.258
Authors: Joyce L Cousins; Richard Wood-Baker; Peter A B Wark; Ian A Yang; Peter G Gibson; Anastasia Hutchinson; Dimitar Sajkov; Sarah A Hiles; Sameh Samuel; Vanessa M McDonald Journal: ERJ Open Res Date: 2020-04-19