Emergency department case volume and patient outcomes in acute exacerbations of chronic obstructive pulmonary disease
Abstract
OBJECTIVES: The objective was to determine whether emergency department (ED) case volume of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with patient outcomes in AECOPD.
METHODS: The authors analyzed the 2007 Nationwide Emergency Department Sample (NEDS), the largest publicly available all-payer ED database in the United States. ED visits for AECOPD were identified with a principal diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 491.21. EDs were categorized into quartiles by ED case volume of AECOPD. The primary outcome measures were early inpatient mortality (within the first 3 days of admission) and hospital length of stay (LOS).
RESULTS: The 2007 NEDS sample contained 126,045 ED visits for AECOPD from 946 U.S. EDs; 58% were hospitalized. Of these, the overall inpatient mortality rate was 2.0%, the early inpatient mortality 0.6%, and the median hospital LOS 4 days. Early inpatient mortality was lower in the highest-volume EDs (0.47%), compared with the lowest-volume EDs (1.13%). In a multivariable analysis adjusting for 37 patient and hospital characteristics, early inpatient mortality remained lower in patients admitted through the highest-volume EDs (adjusted odds ratios [ORs] = 0.51; 95% confidence interval [CI] = 0.32 to 0.82), compared with the lowest-volume EDs; however, the hospital LOS in the highest-volume EDs was slightly longer (adjusted difference in LOS = 0.53…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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