title: Mortality after an emergency department visit for exacerbation of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To describe the mortality after emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation.
  
  
  METHODS
  Retrospective cohort study of ED patients with COPD exacerbation. Setting. Administrative data analysis.
  
  
  METHODS
  Patients age 55 and over who visited the ED during a 2-year period with primary ICD-9 codes of 491, 492, or 496.
  
  
  METHODS
  Demographic characteristics, comorbid conditions, hospital utilization for COPD, and vital status.
  
  
  RESULTS
  During the study period, there were 482 index visits with a median follow-up of 1,128 days (3.1 years). Demographic characteristics of the cohort were as follows: mean age 72 years, 56% female, 93% White, and 37% currently married. Mortality increased over time: 5% at 30 days, 9% at 60 days, 11% at 90 days, 16% at 180 days, 23% at 1 year, 32% at 2 years, and 39% at 3 years. At the end of follow-up, 220 (46%) patients had died. On multivariate analysis, independent predictors of mortality were increasing age (hazard ratio [HR] 1.3 per 5-year increase, 95% CI 1.2-1.4), having congestive heart failure (HR 1.6, 95% CI 1.2-2.1), having metastatic solid tumor (HR 3.3, 95% CI 2.0-5.5), and hospital utilization for COPD exacerbation during past year (HR 1.9, 95% CI 1.4-2.6).
  
  
  CONCLUSIONS
  The mortality rate after an ED visit for COPD exacerbation is quite high. Mortality is related to older age, specific comorbid conditions, and history of prior COPD exacerbations.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. sunghyekim2000@yahoo.com
authors.forename: Sunghye
authors.initials: S
authors.lastname: Kim
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000368:Aged; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors