title: Long-term prognosis for patients with COPD treated in the prehospital setting: Is it influenced by hospital admission?
abstract: OBJECTIVE
  Our aim was to assess long-term prognosis for patients with an exacerbation of COPD who were treated by the anesthesiologists of the Mobile Emergency Care Unit (MECU) of Copenhagen. We specifically sought to examine whether mortality was different among patients released before hospital admission and those admitted to the hospital.
  
  
  METHODS
  An observational cohort study with 5-year follow-up.
  
  
  METHODS
  Prehospital and university hospital.
  
  
  METHODS
  Patients with exacerbation of COPD treated by the MECU.
  
  
  METHODS
  We included all patients treated from 2000 to 2001. In September 2005, we conducted a search to find out whether these patients were still alive, and we analyzed survival using Kaplan-Meier statistics and log-rank test. Patients admitted to the hospital (primarily or secondarily) were compared to patients treated and released before hospital admission.
  
  
  RESULTS
  In total, 573 patients with COPD had 995 episodes of exacerbation treated by the MECU in the 2-year period. On September 1, 2005, only 155 patients (27%) were alive. In 245 of the exacerbation episodes (25%) among 163 patients, hospital admission was not necessary primarily, but in 42 of these exacerbations (17%), secondary admission occurred within 48 h. Mortality was significantly higher (p = 0.02) in patients admitted to the hospital either primarily or secondarily, compared to patients treated and released before admission to the hospital.
  
  
  CONCLUSIONS
  Mortality was high among COPD patients. Less than one fifth of patients treated at home and released are admitted to hospital secondarily. Mortality was significantly higher among admitted patients. A set of criteria selecting the patient prone to secondary admission is desirable.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark. jacobsteinmetz@dadlnet.dk
authors.forename: Jacob
authors.initials: J
authors.lastname: Steinmetz
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
authors.forename: Søren L
authors.initials: SL
authors.lastname: Nielsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D015996:Survival Rate
chemical_list: D001993:Bronchodilator Agents