Prehospital prognosis is difficult in patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

BackgroundPatients with acute exacerbation of chronic obstructive pulmonary disease often require prehospital emergency treatment. This enables patients who are less ill to be treated on-site and to avoid hospital admission, while severely ill patients can receive immediate ventilatory support in the form of intubation. The emergency physician faces difficult treatment decisions, however, and prognostic tools that could assist in determining which patients would benefit from intubation and ventilator support would be helpful. The aim of the current study was to identify prehospital clinical variables associated with mortality from acute exacerbation of chronic obstructive pulmonary disease. As part of the study, we estimated the 30-day mortality for patients with this prehospital diagnosis.MethodsA retrospective study was performed using data collected by the mobile emergency care unit in Odense, Denmark, combined with data from the patients’ medical records. Patients with the tentative diagnosis of acute exacerbation of chronic obstructive pulmonary disease between 1st July 2011 and 31st December 2013 were included in the study.ResultsBased on data from 530 patients, we found no statistically significant associations between prehospital clinical variables and mortality, apart from a minor association between older age and higher mortality. The overall 30-day mortality was 10%, while that for patients admitted to the intensive care unit was 30%.ConclusionNo specific prehospital prognostic factors for mortality were identified. Prognostic assessment and the decision to withhold treatment for acute exacerbation of chronic obstructive pulmonary disease seem inadvisable in the prehospital setting.

Prehospital emergency medical technicians can perform ultrasonography and blood analysis in prehospital evaluation of patients with chronic obstructive pulmonary disease: a feasibility study

“…General home care of patients with COPD is already an established possibility in some countries [ 22 ]. It has further been reported that the majority of acute COPD patients receiving care in the EDs are discharged within 24 h of the admission [ 6 , 7 ]. A logical notion thus could be that patients with acute exacerbations of COPD also to some extent could be treated in their homes.…”

“…Although previously diagnosed with COPD, a large proportion of the patients initially screened had called the emergency medical services for complaints that could not solely be attributed to an exacerbation of COPD. Previously, we have shown that the prehospital clinical characteristics of COPD patients does not allow for prognostication as patients with COPD constitute a very disperse group [ 7 ]. As our study clearly shows, there are thus limitations to the level of ambitions regarding treat-and-release of patients solely suffering from COPD.…”

“…Patients with acute exacerbations in chronic obstructive pulmonary disease (AE-COPD) are frequently transported to the emergency room of the hospital. In many cases, these patients are discharged shortly after admission following a brief treatment consisting of broncholytics and in some cases corticosteroids and antibiotics [ 6 , 7 ]. The transport of these patients for very short stays at the hospital have both implications for health service costs as well as for the patients’ well-being.…”

2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force

“…Age, medical history, abnormal vital signs, electrocardiography (ECG) findings, pain symptoms, and the delay between symptom onset and call time are important factors for early risk assessment during the prehospital evaluation of a patient whose main complaint is dyspnea. [ 8 ] It is difficult to determine prognostic markers for mortality in patients with suspected COPD exacerbation in the prehospital setting. It has been reported that on-site treatment may be sufficient in 10% of patients with exacerbation and 30% of the patients brought to the hospital are discharged within 24 h, but mechanical ventilation is required in 6% of the patients, and the 30-day mortality is 30%.…”

Patients’ perspectives on point-of-care diagnostics and treatment by emergency medical technicians in acute COPD exacerbations: A qualitative study

“…Often the patients are treated for their exacerbation at the ED with bronchodilators, corticosteroids, and if appropriate also antibiotics [ 5 , 7 ]. If other comorbidities are excluded and the patient responds to the initial treatment, the patient will typically be discharged after a short evaluation within 24 h of admission [ 8 ]. This transport and assessment at the hospital may be inconvenient for the patients’ and relatives’ life quality, wellbeing, and pose a risk for nosocomial infection.…”