Evaluation of the quality of emergency department management for patients with chronic obstructive pulmonary disease.

IF 1.9 Q2 EMERGENCY MEDICINE Clinical and Experimental Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI:10.15441/ceem.24.197
Pascale J King, Lana Ramic, Janet Wilson, Shawn Aaron, Ian G Stiell
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Abstract

Objective: Chronic obstructive pulmonary disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the emergency department (ED) management of COPD exacerbations.

Methods: This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes included intensive care unit admission, intubation, myocardial infarction, noninvasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori.

Results: We enrolled 500 cases with mean age of 71.9 years, 51.2% female patients, 50.2% admitted, and 4.4% death. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled β-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%), and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled β-agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%).

Conclusion: Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.

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慢性阻塞性肺病患者 ED 管理质量评估。
背景:慢性阻塞性肺病(COPD慢性阻塞性肺病(COPD)与病情恶化和严重后果的高风险有关。我们的目标是确定急诊室对慢性阻塞性肺病加重的处理是否适当:这项观察性队列研究纳入了健康记录审查,包括在两家大型学术性急诊室就诊的慢性阻塞性肺病加重病例。我们纳入了所有主要诊断为慢性阻塞性肺病加重的患者。我们从电子病历中摘录了人口统计学和临床数据,并计算了每位患者的渥太华慢性阻塞性肺病风险评分(OCRS)。短期严重后果(SSO)包括入住重症监护室、插管、心肌梗死、无创正压通气(NIV)和 30 天后死亡。根据事先制定的明确适应症和标准来判断病例治疗的适当性:我们登记了 500 例病例,平均年龄 71.9 岁,女性 51.2%,入院 50.2%,死亡 4.4%。经计算,70.8%的患者 OCRS 评分大于 2 分。提供的治疗包括吸入β-激动剂(82.6%)、吸入抗胆碱能药物(76.6%)、皮质类固醇(75.2%)、抗生素(71.0%)、氧气(63.8%)、NIV(8.8%)和插管(0.6%)。总体而言,有 50.0% 的病例因治疗缺失而被判定为治疗不当。具体而言,缺失治疗的比例为吸入β受体激动剂(17.0%)、吸入抗胆碱能药物(22.6%)、皮质类固醇(24.4%)、抗生素(12.8%)和 NIV(2.0%):结论:在这两家大型学术性急诊室中,50.0%的慢性阻塞性肺疾病恶化患者未得到适当治疗。未接受皮质类固醇或抗生素治疗的患者人数令人担忧。实施明确的治疗标准应能改善对这种常见严重疾病患者的护理。
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CiteScore
2.80
自引率
10.50%
发文量
59
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