Ann Hutchinson, Alastair Pickering, Paul Williams, Miriam Johnson
Abstract
Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions. Acute-on-chronic breathlessness is a reason for 20% of emergency presentations by ambulance with 69% of these being admitted. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness.
Introduction
Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions [1, 2]. Its intensity on arrival at the emergency department predicts hospital admission [3]. Acute-on-chronic breathlessness [4] is a reason for one fifth of emergency department presentations by ambulance with between half to two-thirds of these being admitted [1, 5]. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness [6], of whom one-third can be discharged home [1, 7].
Materials and methods
We conducted a secondary analysis of survey and clinical record data from those presenting due to acute-on-chronic breathlessness to the major emergencies area of a single tertiary hospital. Primary findings and detailed methods are reported elsewhere [1]. Collected data included: socio-demographic characteristics, medical conditions, breathlessness (severity now/at call-out; duration), respiratory measures on arrival (oxygen saturation, respiratory rate), previous presentations, and the decision-maker regarding emergency call-out (self/carer/clinician).
Results
In the final model, the odds of admission were increased with every extra year of age [OR 1.041 (95% CI: 1.016 to 1.066)], having talked to a specialist doctor about breathlessness [9.262 (1.066 to 10.386)] and a known heart condition [4.177 (1.680 to 10.386)] and were decreased with every percentage increase in oxygen saturation [0.826 (0.701 to 0.974)] (see Table 1).
Discussion
The identified predictors are simple and non-invasive, measurable by community clinicians. Our findings may be useful to aid clinical decision-making regarding conveyance to the emergency department and help prevent attendance by those who settle quickly and would be discharged back home. Additionally, these predictors might be useful at triage in the emergency department to expedite the admission of those most in need. Confirmation of our findings with a larger dataset from community-collected data is needed before being applied in clinical practice. Designs could include quasi-experimental approaches based on propensity score matching to address confounding to test different possible interventions and the usefulness of candidate predictors in clinical practice.
Conclusions
Admission from the emergency department was predicted by increased age, decreased oxygen saturation on presentation, having talked to a specialist doctor about breathlessness, and a history of a cardiac condition. These clinical factors can be measured by community clinicians and consideration may result in fewer unnecessary emergency department presentations with more patients being managed appropriately in the community.
Acknowledgments
We wish to acknowledge the contribution of Martin Bland to the statistical analysis.
Citation: Hutchinson A, Pickering A, Williams P, Johnson M (2023) Predictors of hospital admission when presenting with acute-on-chronic
breathlessness: Binary logistic regression. PLoS ONE 18(8): e0289263. https://doi.org/10.1371/journal.pone.0289263
Editor: Filomena Pietrantonio, San Giuseppe Hospital, ITALY
Received: August 2, 2021; Accepted: July 14, 2023; Published: August 15, 2023
Copyright: © 2023 Hutchinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: An anonymized minimal dataset is available on request by qualifying researchers to the corresponding author or to the administrator of the Wolfson Centre for Palliative Care Research [email protected], subject to an appropriate data sharing agreement in place beforehand.
Funding: AH received a PhD studentship funded by the University of Hull. AH, MJ and AP received funding from NHS Hull Clinical Commissioning Group. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0289263#abstract0
