Abstract
Objective We aimed to identify factors associated with treatment failure in patients with acute exacerbation of COPD (AECOPD) admitted to the emergency department observation unit (EDOU). Methods A retrospective cohort study was conducted between January 1, 2013, and October 31, 2019. The electronic medical records were reviewed of patients with AECOPD admitted to the EDOU. The patients were divided into treatment failure and treatment success groups. Treatment failure was defined as prolonged stay at the EDOU (>48 h) or COPD-related ED revisit (within 72 h) or readmission within 1 month. The two groups were compared and analyzed using univariable and multivariable analyses by logistic regression. Results Of the 220 patients enrolled, 82 (37.3%) developed treatment failure. Factors associated with treatment failure included arrhythmias (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.04–13.9), diabetic mellitus (OR 2.32, 95% CI 1.09–4.95), long-term oxygen therapy (OR 2.89, 95% CI 1.08–7.72), short-acting beta-agonist use (OR 6.06, 95% CI 1.98–18.62), pneumonia findings on chest X-ray (OR 3.24, 95% CI 1.06–9.95), and ED length of stay less than 4 h (OR 2, 95% CI 1.08–3.73). Conclusion Arrhythmias, diabetic mellitus, long-term oxygen therapy, short-acting beta-agonist use, pneumonia findings on chest X-ray, and ED length of stay <4 h were the significant factors associated with treatment failure of AECOPD to which physicians at the ED should pay special attention before the admission of patients to the EDOU.
Highlights
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are undesirable events in the course of the disease for most COPD patients
No previous study evaluated the factors associated with treatment failure in patients with AECOPD who were admitted to the emergency department observation unit (EDOU). erefore, this study aimed to identify the factors associated with treatment failure in patients with AECOPD who were admitted to the EDOU
Eleven patients (6%) were discharged from the EDOU with an EDOU length of stay >48 h. e numbers of patients who revisited the emergency department (ED) within 72 h, who were readmitted into the hospital within 1 month, and who were readmitted to the EDOU within 1 month were six (3.3%), 10 (5.5%), and 17 (9.3%), respectively
Summary
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are undesirable events in the course of the disease for most COPD patients. E emergency department observation unit (EDOU) is a designated area near the ED that is designed to accommodate patients who require a short period of observation or therapy, yet do not require inpatient admission to a ward. It is useful in decreasing the number of admissions and reducing health care costs for management by treatment, observation, and discharge of patients within 48 h [8]. A previous study stated that the availability of an EDOU can Emergency Medicine International decrease hospital AECOPD admissions without affecting the number of patients discharged directly from the ED [8]
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