Emergency department management of acute exacerbations of chronic obstructive pulmonary disease: factors predicting readmission

• Published in: International journal of chronic obstructive pulmonary disease 2018-01, Vol.13, p.1647-1654
• Main Authors: Bartels, Wiebke, Adamson, Simon, Leung, Lisa, Sin, Don D, van Eeden, Stephan F
• Format: Article
• Language: English
• Subjects: Aged; Analysis; British Columbia; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Chronic Obstructive Pulmonary Disease Acute exacerbation Re-admissions Management; Comorbidity; Demographics; Disease Progression; Emergency Service, Hospital - statistics & numerical data; Ethics; Female; Forced Expiratory Volume; Health aspects; Hospital emergency services; Hospitalization; Humans; Laboratories; Lung diseases; Male; Medical research; Mental disorders; Middle Aged; Morbidity; Mortality; Oral drugs; Original Research; Patient Readmission - statistics & numerical data; Patients; Personal information; Prognosis; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Quality of life; Regression Analysis; Respiratory system agents; Respiratory tract diseases; Retrospective Studies; Substance abuse; Time Factors; Triage - statistics & numerical data; Variables
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S163250

Readmissions are common following acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and are partially responsible for increased morbidity and mortality in COPD. Numerous factors have been shown to predict readmission of patients previously admitted to hospital for AECOPD; however, factors related to readmission in patients who are triaged in emergency departments (EDs) and sent directly home are poorly understood. We postulate that patients seen in the ED for AECOPD and directly sent home have a high readmission rate, and we suspect that inadequate management and follow-up contribute to this high readmission rate. We conducted a 1-year retrospective study of all patients seen in the ED for AECOPD at an inner-city tertiary care hospital; 30- and 90-day readmission rates for COPD and all-cause admissions to the ED and hospital were determined. Patients discharged directly home from the ED were compared with those admitted to hospital for management. Patient, treatment, and system variables that could potentially impact readmission were documented. Multivariate Poisson regression models were used to determine which factors predicted readmissions. The readmission rates in the ED group (n=240) were significantly higher than that in the hospitalized group (n=271): 1) the 90-day ED readmissions (1.29 vs 0.51,