Factors Associated with Hospitalization of Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation in the Emergency Department, Rajavithi Hospital
Kittiyaporn Wiwatcharagoses MD*, Kwanchanog Lueweeravong MD*
Affiliation : * Department of Emergency Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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.
Material and Method: 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 (SPSS v17) 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.
Conclusion : 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.
Keywords : COPD, Chronic obstructive pulmonary disease, Acute exacerbation, Hospital admission, Emergency department
