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首页> 外文期刊>COPD: Journal of Chronic Obstructive Pulmonary Disease >Acute exacerbations of COPD: delay in presentation and the risk of hospitalization.
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Acute exacerbations of COPD: delay in presentation and the risk of hospitalization.

机译：COPD的急性加重：出诊延迟和住院风险。

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To determine if a delay in presentation to the emergency department (ED) after the onset of symptoms of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of hospital admission. A prospective cohort study utilizing data from 396 patient visits to 29 North American EDs. Inclusion criteria were age > or = 55 years; a diagnosis of COPD; and presentation for treatment of AECOPD, as defined by increasing shortness of breath, worsening cough, or change in sputum production at presentation. The median age was 69 years and 54% were female. Most patients (70%) presented to the ED > 24 hours after symptom onset, and most (61%) were hospitalized. On multivariate logistic regression analysis, after adjusting for 12 potential confounders (including demographics, clinical features, other diagnoses, and bronchodilator use before arrival), a delay in presentation > or = 24 hours was associated with a over two-fold increase in the odds of admission (odds ratio = 2.2, 95% confidence interval 1.1-4.8). This increase in risk persisted for delay in presentation > or = 12 hours in place of 24 hours, after restricting the analysis to patients admitted outside the intensive care unit, and to those reporting the ED as their usual site of care. A majority of patients delay presentation to the ED for > or = 24 hours after symptom onset, and are at higher risk of hospitalization. Early presentation should be emphasized to patients and caregivers to advance efforts to decrease the morbidity, mortality, and costs of AECOPD treatment.
机译：为了确定在慢性阻塞性肺疾病（AECOPD）急性加重症状发作后延迟到急诊科（ED）的住院时间是否增加了入院的风险。一项前瞻性队列研究利用了来自396位北美29位ED的患者就诊数据。入选标准为年龄>或= 55岁;诊断COPD; AECOPD的治疗方法和治疗方法，即通过增加呼吸急促，加重咳嗽或改变痰液产生来定义。中位年龄为69岁，女性占54％。多数患者（70％）在症状发作后24小时内就诊ED，大多数（61％）入院。在多因素logistic回归分析中，在调整了12种潜在的混杂因素（包括人口统计学，临床特征，其他诊断以及到达之前使用支气管扩张剂）后，呈报延迟>或= 24小时与赔率增加两倍以上相关入院率（赔率= 2.2，95％置信区间1.1-4.8）。在将分析限制在重症监护病房以外收治的患者以及将ED作为常规护理地点的患者进行分析之后，这种风险增加持续导致延迟就诊> 24小时而不是12小时。大多数患者在症状发作后延迟到ED≥24小时，并且住院风险更高。应强调患者和护理人员尽早就诊，以努力降低AECOPD治疗的发病率，死亡率和费用。

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