Smith Hayden L, Ellis Corey S
Department of Medical Education Services, UnityPoint Health-Des Moines, Des Moines, IA.
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA.
Ochsner J. 2021 Spring;21(1):19-24. doi: 10.31486/toj.19.0121.
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. 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. 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. 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.
慢性阻塞性肺疾病（COPD）是一种常见且可预防的疾病。该疾病在美国医疗保健系统中造成了巨大的经济负担。更好地控制和预防COPD急性加重有助于避免患者前往本已拥挤不堪的急诊科（ED）和医院就诊。我们研究的目的是确定与因COPD急性加重而就诊于ED的患者的住院状态相关的变量。我们对2012年至2014年在美国3家ED中的1家就诊的患者进行了一项回顾性观察研究，这些患者的主要诊断与COPD急性加重相关。通过自适应最小绝对收缩和选择算子逻辑回归，使用患者特征数据对住院状态进行建模。研究结果以调整后的比值比及95%置信区间呈现。进行了计划中的事后模型依赖性和外部数据敏感性分析。研究样本包括1165例患有COPD且在3家被审查医院中的1家因急性加重而到ED就诊的独特患者。这些患者中约一半住院。与住院呈负相关的变量包括血氧饱和度和既往因COPD急性加重而到ED就诊的次数。与住院呈正相关的变量是初始ED心率、患者年龄以及记录在案的焦虑和/或抑郁合并症。这些心理健康合并症与住院状态的关联最为强烈。了解住院患者的特征可能有助于指导资源分配和门诊服务以预防就诊。值得注意的是，该研究揭示心理健康变量与住院状态密切相关。
