Hyams Catherine, Challen Robert, Lahuerta Maria, Begier Elizabeth, McGuinness Serena, Clout Madeleine, Southern Jo, Campling James, Oliver Jennifer, Theilacker Christian, Ellsbury Gillian, Maskell Nick, Gessner Bradford D, Danon Leon, Finn Adam
Bristol Vaccine Centre, University of Bristol, Bristol, UK
Academic Respiratory Unit, Department of Clinical Sciences, Bristol University, Bristol, UK.
BMJ Open Respir Res. 2025 May 16;12(1):e002572. doi: 10.1136/bmjresp-2024-002572.
Recent reports highlight the importance of acute lower respiratory tract disease (aLRTD) for patients, but data describing incidence and burden in emergency departments (ED) are lacking.
A cohort study ascertaining cases prospectively at two EDs in Bristol, UK, enrolling adults (≥18 years) presenting with aLRTD from 1 August 2022 to 31 July 2023. Multivariate logistic regression modelled risk of hospitalisation. Incidence was estimated per 1000 person-years, using adult population estimates for the AvonCAP study catchment area.
151 865 ED visits, with 9452 (6.2%) aLRTD cases: 2376 (25%) were discharged and 7076 (75%) subsequently hospitalised, including:3663 (38.8%) pneumonia, 4167 (44.1%) non-pneumonic lower respiratory tract infection and 1622 (17.2%) cases without evidence of infection. Univariate analysis demonstrated that aLRTD patients discharged were younger than those hospitalised (median age 43.4 years, IQR 29.4-62.3 vs 74.0 years, IQR 59.8-83.5), and less likely to have pneumonia (17.0% vs 46.0%, respectively). Smoking, heart failure at presentation and underlying chronic cardiac disease conferred risk of admission, above an age effect in the adjusted logistic regression model.Total ED aLRTD incidence was 12.8/1000 person-years (9.6 admitted, 3.2 seen and discharged), with incidences of 7.0 and 36.8/1000 person-years in 18-64 years and ≥65 years, respectively, and incidence increased with patient age: 39.5 and 82.5/1000 person-years in 75-84 years and ≥85 years age groups, respectively.
We report a higher ED aLRTD incidence than in recent British Thoracic Society and Getting It Right First Time reports. This is concerning, particularly in older adults, and may be reduced by respiratory disease optimisation and public health initiatives including smoking cessation and vaccination programmes.
近期报告强调了急性下呼吸道疾病（aLRTD）对患者的重要性，但缺乏描述急诊科（ED）发病率和负担的数据。
一项队列研究前瞻性地确定英国布里斯托尔两家急诊科的病例，纳入2022年8月1日至2023年7月31日期间因aLRTD就诊的成年人（≥18岁）。多变量逻辑回归对住院风险进行建模。使用雅芳郡社区评估项目（AvonCAP）研究集水区的成年人口估计数，每1000人年估计发病率。
151865人次急诊就诊，其中9452例（6.2%）为aLRTD病例：2376例（25%）出院，7076例（75%）随后住院，包括：3663例（38.8%）肺炎，4167例（44.1%）非肺炎性下呼吸道感染，1622例（17.2%）无感染证据的病例。单变量分析表明，出院的aLRTD患者比住院患者年轻（中位年龄43.4岁，四分位间距29.4 - 62.3岁，而住院患者为74.0岁，四分位间距59.8 - 83.5岁），且患肺炎的可能性较小（分别为17.0%和46.0%）。在调整后的逻辑回归模型中，吸烟、就诊时的心力衰竭和潜在的慢性心脏病除了年龄效应外，还增加了入院风险。急诊aLRTD总发病率为12.8/1000人年（9.6例入院，3.2例就诊后出院），18 - 64岁和≥65岁的发病率分别为7.0/1000人年和36.8/1000人年，发病率随患者年龄增加而上升：75 - 84岁和≥85岁年龄组分别为39.5/1000人年和82.5/1000人年。
我们报告的急诊aLRTD发病率高于英国胸科学会和“首次正确处理”近期报告中的发病率。这令人担忧，尤其是在老年人中，通过优化呼吸道疾病以及包括戒烟和疫苗接种计划在内的公共卫生举措，发病率可能会降低。
