Factors Associated with Hospitalization of Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation in the Emergency Department, Rajavithi Hospital.
BACKGROUND
Chronic Obstructive Pulmonary Disease with acute exacerbation (AECOPD) is a condition, which frequently results in patients visiting the emergency department (ED). Recently, many studies have reported new factors, which cause AECOPD-patients (AECOPDs) to require urgent hospital admission.


OBJECTIVE
To determine the crucial factors of AECOPDs that are associated with patients who visit the ED being admitted to Rajavithi Hospital.


METHODS
This retrospective cross-sectional study was performed from May 1, 2011 to June 30, 2013. Seventy patients were included and their medical records were reviewed. A logistic regression model (SPSSv17) was used to analyze the prognostic factors associated with hospitalization.


RESULTS
The study found that patients with a respiratory rate >24 breaths per minute (OR = 3.43; 95% CI = 1.10-10.84; p = 0.040), pulse rate >120 beats per minute (OR = 4.10; 95% CI = 1.31-12.74; p = 0.020), and oxygen saturation <90% (OR = 5.25; 95% CI = 1.20-23.00; p = 0.030), were prone to be admitted to the hospital. Furthermore, such patients more often required hospitalization if they had met any of the following criteria: had respiratory-infection related Global Initiative for Chronic Obstructive Lung Disease standard stages 3-4; were receiving home oxygen therapy; had an annual rate of ED visits of more than 2; had higher leukocytes; classified in the ED emergency triage as emergent; or who received antibiotics at the ED.


CONCLUSIONS
Respiratory rate, heart rate and oxygen saturation are the crucial symptoms of AECOPDs to which physicians at ED should pay special attention. Such factors are reasonable indicators for hospitalization in order to reduce ED overcrowding. The study also found that patients treated early with antibiotics in the ED may be associated with subsequent hospitalization for ongoing management. However further studies are required for verification.
Kittiyaporn
K
Wiwatcharagoses
Kwanchanog
K
Lueweeravong
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents