Evaluation of the Quality of ED Management for Patients with COPD

King, Pascale J.; Ramic, Lana; Wilson, Janet; Aaron, Shawn; Stiell, Ian G.

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Clin Exp Emerg Med > Accepted Articles

Original Article

doi: https://doi.org/10.15441/ceem.24.197 [Accepted]

Evaluation of the Quality of ED Management for Patients with COPD

Pascale J. King¹, Lana Ramic⁴, Janet Wilson⁴, Shawn Aaron³, Ian G. Stiell²

¹Department of Emergency Medicine, University of Ottawa
²Department of Emergency Medicine, University of Ottawa; Ottawa Hospital Research Institute
³Department of Medicine, University of Ottawa; Ottawa Hospital Research Institute
⁴Faculty of Medicine, University of Ottawa

Correspondence Ian G. Stiell Email: istiell@ohri.ca

Received: February 5, 2024. Revised: April 15, 2024. Accepted: April 16, 2024. Published online: May 23, 2024.

ABSTRACT

BACKGROUND
Chronic Obstructive Pulmonary Disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the ED management of COPD exacerbations.
METHODS
This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes (SSO) included ICU admission, intubation, myocardial infarction, non-invasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori.
RESULTS
We enrolled 500 cases with mean age 71.9, female 51.2%, admitted 50.2%, and death 4.4%. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled beta-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%) and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled beta agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%).
CONCLUSIONS
Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.

Keywords: Emergency Department, Chronic Obstructive Pulmonary Disease, Chronic Obstructive Pulmonary Disease Exacerbation, Infection, Steroids, Antibiotics