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Emergency Department Case Volume and Patient Outcomes in Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Academic Emergency Medicine, 06/12/2012
Tsai CL et al. – Emergency department (ED) patients who are hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have an approximately 50% reduction in early inpatient mortality if they were admitted from an ED that handles a large volume of AECOPD cases.
Methods- The authors analyzed the 2007 Nationwide Emergency Department Sample (NEDS), the largest publicly available all–payer ED database in the United States.
- ED visits for AECOPD were identified with a principal diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) code 491.21.
- EDs were categorized into quartiles by ED case volume of AECOPD.
- The primary outcome measures were early inpatient mortality (within the first 3days of admission) and hospital length of stay (LOS).
- The 2007 NEDS sample contained 126,045 ED visits for AECOPD from 946 U.S. EDs; 58% were hospitalized.
- Of these, the overall inpatient mortality rate was 2.0%, the early inpatient mortality 0.6%, and the median hospital LOS 4days.
- Early inpatient mortality was lower in the highest–volume EDs (0.47%), compared with the lowest–volume EDs (1.13%).
- In a multivariable analysis adjusting for 37 patient and hospital characteristics, early inpatient mortality remained lower in patients admitted through the highest–volume EDs (adjusted odds ratios [ORs]=0.51; 95% confidence interval [CI]=0.32 to 0.82), compared with the lowest–volume EDs; however, the hospital LOS in the highest–volume EDs was slightly longer (adjusted difference in LOS=0.53day; 95% CI=0.29 to 0.77).
- The volume threshold for reduced early mortality was approximately 200 cases per year.