title: Emergency department management of acute exacerbations of chronic obstructive pulmonary disease and factors associated with hospitalization.
abstract: BACKGROUND
  Currently there is a paucity of information about biomarkers that can predict hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients presenting to the emergency department (ED). There is limited data on the consistency of ED management of AECOPD with local COPD guidelines. The aim of this study was to identify biomarkers associated with hospitalization in AECOPD patients and to determine if the ED management was concordant with local COPD guidelines.
  
  
  METHODS
  We performed a retrospective audit of consecutive AECOPD patients presenting to the Gold Coast Hospital ED over a 6-month period.
  
  
  RESULTS
  During the study period, 122 AECOPD patients (51% male, mean age (SE) 71 (±11) years) presented to the ED. Ninety-eight (80%) patients were hospitalized. Univariate analysis identified certain factors associated with hospitalization: Older age, former smokers, home oxygen therapy, weekday presentation, SpO2 < 92%, and raised inflammatory markers (white cell count (WCC) and C-reactive protein (CRP)). After adjustment for multiple variable, increased age was significantly associated with hospitalization (odds ratio (OR) 1.09; 95% confidence interval (CI): 1.00-1.18; P = 0.05). Radiology assessment and pharmacological management was in accordance with COPD guidelines. However, spirometry was performed in 17% of patients and 28% of patients with hypercapneic respiratory failure received noninvasive ventilation (NIV).
  
  
  CONCLUSIONS
  We identified several factors on univariate analysis that were associated with hospitalization. Further research is required to determine the utility of these biomarkers in clinical practice. Also, while overall adherence to local COPD guidelines was good, there is scope for improvement in performing spirometry and provision of NIV to eligible patients.
authors.affiliation: Department of Respiratory Medicine, Gold Coast University Hospital, Australia.
authors.forename: Bharat
authors.initials: B
authors.lastname: Khialani
authors.affiliation: Department of Respiratory Medicine, Gold Coast University Hospital, Australia ; School of Medicine, Parklands Drive, Griffith University, Queensland, Australia.
authors.forename: Pathmanathan
authors.initials: P
authors.lastname: Sivakumaran
authors.affiliation: School of Medicine, Parklands Drive, Griffith University, Queensland, Australia ; Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia ; School of Medicine, Bond University, 4 University Dr, Robina Queensland 4226, Australia.
authors.forename: Gerben
authors.initials: G
authors.lastname: Keijzers
authors.affiliation: Department of Respiratory Medicine, Gold Coast University Hospital, Australia ; School of Medicine, Parklands Drive, Griffith University, Queensland, Australia.
authors.forename: Krishna Bajee
authors.initials: KB
authors.lastname: Sriram
keywords: Emergencies; lung disease; obstructive
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