Summary

Quality of life in exacerbated chronic obstructive pulmonary disease emergencies: influence on the decision to admit patients and relation to poor outcome at 2 months

Pulido Herrero E, García Gutiérrez S, Antón Ladislao A, Piñera Salmerón P, Quintana López JM, Gallardo Rebollal MS, Sánchez Fernández M, Ortega Marcos ME, Amigo Angulo JM

Affiliation of the authors

Servicio de Urgencias, OSIBarrualdea- Galdakao, Galdakao, Bizkaia, Spain. Unidad de Investigación, OSI Barrualde-Galdakao, Galdakao, Bizkaia, Spain. Servicio de Urgencias, Hospital Reina Sofía, Murcia, Spain.

DOI

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Pulido Herrero E, García Gutiérrez S, Antón Ladislao A, Piñera Salmerón P, Quintana López JM, Gallardo Rebollal MS, et al. Quality of life in exacerbated chronic obstructive pulmonary disease emergencies: influence on the decision to admit patients and relation to poor outcome at 2 months. Emergencias. 2016;28:387-95

Summary

Objective.

To study the influence of quality of life on the decision to admit patients attended for exacerbated chronic obstructive pulmonary disease (COPD) in a hospital emergency department (ED) and to explore the association with poor outcome at 2 months.

Methods.

Prospective study of a cohort of patients with exacerbated COPD attended in an ED between November 2011 and September 2012. We collected sociodemographic and clinical data as well as scores on the COPD Assessment Test (CAT), the modified scale of the Medical Research Council, and the Borg scale for Perceived Dyspnea at the

following times: baseline (clinically stable) (t0), on exacerbation (emergency) (t1), 15 days later or on discharge (t2), and 2 months after the emergency (t3). The outcome measures were hospital admission, revisits to the ED, and readmission within 2 months of the exacerbation.

Results.

A total of 191 patients treated for exacerbated COPD were included. The mean (SD) age was 74.9 (10.2) years; 173 (90.6%) were men. The exacerbations were mild in 97 cases (56.4%). The median (interquartile range) CAT scores were 14.5 (9–21), 20 (15–28), 16 (10–22), and 14.5 (10–21) at t0, t1, t2 and t3, respectively. One hundred

twenty-three patients (64.4%) were admitted, 68 (35.6%) revisited the ED, and 39 (20.4%) were readmitted within 2 months. A high level of disease impact on quality of life at t1 (vs low impact) was independently associated with hospital admission (adjusted odds ratio [OR], 3.7; 95% CI, 1.0–13.2; P=.043). Impact on t2 was associated with a revisit

within 2 months (adjusted OR, 3.6; 95% CI, 1.1–11.7; P=.031). Minimal change between the t1 and t2 CAT scores was independently associated with an ED revisit within 2 months (adjusted OR, 2.9; 95% CI, 1.2–7.4; P=.023). When the data for patients discharged from the ED were analyzed separately from those for admitted patients, the differences

were statistically significant only for those who had been hospitalized.

Conclusion. The CAT score could be useful for predicting hospital admissions and revisiting within 2 months, especially in patients admitted for exacerbated COPD.

 

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Amigo Angulo JM, Antón Ladislao A, Gallardo Rebollal MS, García-Gutiérrez S, Ortega Marcos ME, Piñera Salmerón P, Pulido Herrero E, Quintana López JM, Sánchez Fernández M

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