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

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Abstract

Background: Patients 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. Methods: A 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. Results: Based 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%. Conclusion: No 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.

Original languageEnglish
Article number106
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume25
Number of pages7
ISSN1757-7241
DOIs
Publication statusPublished - Nov 2017

Keywords

  • Chronic obstructive pulmonary disease
  • Emergency
  • Intensive care
  • Mortality
  • Prehospital
  • Prognostic
  • Decision Making
  • Recurrence
  • Prognosis
  • Humans
  • Middle Aged
  • Male
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Denmark/epidemiology
  • Survival Rate/trends
  • Emergency Medical Services/methods
  • Aged, 80 and over
  • Adult
  • Female
  • Aged
  • Retrospective Studies
  • Ambulances
  • Hospitalization/trends

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