Predictors of emergency department visit disposition for patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVES: The study objective was to validate among patients with chronic obstructive pulmonary disease (COPD) clinical predictors of emergency department (ED) disposition (admission vs discharge) found in a previous study. We hypothesized that the initial heart rate (HR) at presentation and the number of nebulizer treatments would predict visit disposition adequately and that existing triage criteria would not.

METHODS: In this correlational study, all ED visits to a university medical center related to a diagnosis of COPD over a 2-year period were identified and reviewed retrospectively (N = 114 patients and 226 visits). Associations of clinical predictors with visit disposition was by contingency table or receiver operating characteristic curve analysis.

RESULTS: The overall admission rate was 60.2%. An initial HR slightly greater than normal limits (HR >/= 106 vs HR
CONCLUSIONS: The initial HR on arrival predicted disposition of ED visits for patients with COPD with operating characteristics that were superior to the existing triage criteria. Triage of patients with COPD could be improved simply, and at no additional expense, by recognizing that almost any degree of tachycardia in a patient with COPD substantially increases the likelihood of admission.