Tables
- Table 1
Demographics and disease severity at admission
sex Admission Male Female First Re-admission Sex 748 (53) 622 (44) Age 72±9 71±10 FEV1 L 1.09±0.58 0.81±0.39 0.94 (0.66–1.31) 0.71 (0.55–1.00) FEV1 % pred 40±20 42±19 35 (25–49) 39 (28–53) Admission Status 400 (29) 919 (66) Medications recorded at the time of admission Inhaled bronchodilator 285 (71) 674 (73) Long-acting bronchodilator 30 (8) 175 (19) Inhaled steroid 204 (51) 597 (65) Systemic steroid 110 (28) 344 (37) One or more of the above four 327 (82) 845 (92) Home nebuliser 70 (18) 445 (48) Home oxygen 23 (6) 268 (29) Methylxanthine 50 (13) 243 (26) Antibiotic 63 (16) 190 (21) Data presented as n (%), mean±sd and mean (interquartile range)
2% were unknown
6% admission details were unknown
Of the 302 cases in which oxygen was reported, the type was stated as oxygen concentrator in 90 cases, and as a cylinder in 110 cases.
- Table 2
Assessments and measurements on admission
Assessment or measurement made on admission Interhospital variation Overall summary statistics for patients n (%) IQR % range % Mean sd Median IQR Range Increased breathlessness 96% (1347) 93–100 83–100 Symptom present in 96% (1299) Increased sputum volume 70% (987) 52–85 12–100 Symptom present in 58% (574) Change in colour of sputum 68% (948) 53–82 9–100 Symptom present in 53% (502) Bilateral leg oedema 66% (923) 52–77 9–97 Present in 38% (348) Comment on the chest radiograph 65% (916) 53–78 0–98 Infiltrates reported in 26% (242) Respiratory rate bpm 70% (982) 60–86 27–100 27 7 26 22–30 10–60 Temperature oC 86% (1209) 85–97 37–100 36.7 0.8 36.6 26.2–37.2 34.0–40.0 Peak flow l·min−1 46% (648) 30–55 0–88 47 71 140 100–185 10–460 Sa,O2 % 75% (1061) 65–91 5–100 91 8 94 89–96 46–100 pH 79% (1109) 73–90 40–100 7.39 0.9 7.40 7.36–7.45 6.89–7.80 Pa,O2 kPa 6.21 2.18 5.70 4.81–6.91 1.56–21.88 Pa,O2 kPa 10.31 5.0 9.01 7.50–11.32 3.30–48.40 IQR: interquartile range
bpm: beats per minute
Sa,O2: arterial oxygen saturation
Pa,CO2: arterial carbon dioxide tension
Pa,O2: arterial oxygen tension
114 of these the actual value was marked “unrecordable”. Statistical summary is for the 534 with values.
- Table 3
Initial management within 24 h of admission
Formal prescription of level of inspired oxygen Overall 64 (886/1375 known) Sa,O2 ≤92 75 (328/439) >92 62 (377/613) Pa,O2 <8 kPa 76 (269/355) 8–9.99 kPa 71 (231/326) 10+ kPa 68 (282/417) Repeat arterial blood gases Overall 34 (371/1109 done on admission) Pa,CO2 >6.0 kPa 49 (225/456) ≤6.0 kPa 22 (144/642) pH <7.35 63 (141/224) 7.35+ 26 (224/861) Pa,CO2>6.0 kPa & pH<7.35 65 (128/197) Assisted ventilation IPPV NIPPV Overall 3 (40/1400) First COPD 3 (23/919) Re-admission 3 (10/400) Pa,CO2 >6.0 kPa 7 (34/456) ≤6.0 kPa 1 (4/642) PH <7.26 15 (11/72) 7.26–7.34 11 (16/152) 7.35+ 1 (11/861) Pa,CO2>6.0 kPa & pH<7.35 13 (25/197) Medication Nebulized bronchodilator 91 (1267/1400) Steroids 85 (1183/1400) Antibiotics 80 (115/1400) Data presented as % (absolute fraction)
Sa,O2: arterial oxygen saturation
Pa,O2: arterial oxygen tension
Pa,CO2: arterial carbon dioxide tension
IPPV: invasive positive pressure ventilation
NIPPV: noninvasive positive pressure ventilation.
- Table 4
Continuing management
Hospital Variation n (%) IQR % Range % PEF chart record 51 (710) 28–68 5–93 FEV1 or PEF recorded 71 (988) 58–84 26–93 Inhaler technique assessed 20 (241/1218) 4–26 0–90 Smoking cessation advice given: to smokers 30 (134/445) 14–45 0–75 to exsmokers in last months 11 (7/64) 0–0 0–50 Pa,O2>7.3 kPa on air at any time 33 (455) 18–48 0–78 OP follow-up 63 (797/1272) 50–80 22–94 Vaccination advice given 5 (65) 0–7 0–21 Pulmonary rehabilitation recommended 3 (39) 0–3 0–39 Reversibility to bronchodilator 27 (378) 6–38 0–86 Steroid reversibility tested 7 (96) 0–11 0–44 Discharge medication Inhaled bronchodilator 64 (899) 48–80 28–100 Long-acting bronchodilator 15 (209) 5–18 0–69 Inhaled steroid 56 (779) 45–68 14–84 Oral steroid 57 (803) 47–71 7–80 Home nebuliser 38 (536) 30–48 0–86 Home oxygen 18 (254) 10–25 3–40 Theophylline 24 (340) 15–35 0–50 Antibiotics 35 (493) 29–40 5–78 Stated as concentrator in 105 cases and as cylinder in 90
PEF: peak expiratory flow
FEV1: forced expiratory volume in one second
Pa,O2: arterial oxygen tension
OP: outpatient.
- Table 5
Differences in the management of patients under the care of Respiratory Physicians (n=602) and nonrespiratory specialists (n=759) at the time of discharge
Comparison made Chest Physician % Non-specialist % Chi-squared* P‐value 95% CI Inpatient Care FEV1 recorded 70 40 127.4 <0.001 26–36 FEV1 %pred. 49 27 69.2 <0.001 17–27 PEF chart 61 44 35.8 <0.001 6–17 Inhaler technique 21 14 12.1 <0.001 4–13 Smoking advice to current smokers 36 26 4.6 0.03 1–18 Discharge Medications Prescribed Inhaled bronchodilator 66 65 0.2 0.64 −4–6 Inhaled long acting β‐agonist 20 12 16.1 <0.001 4–12 Inhaled steroid 61 53 7.8 0.005 2–13 Oral steroid 61 56 4.3 0.04 0–11 Home nebuliser 49 31 43.1 <0.001 12–23 Home oxygen 24 14 20.9 <0.001 6–14 Theophylline 28 22 7.0 0.008 2–11 Antibiotics 36 36 0.06 0.81 −5–6 Discharge plans Follow up arranged 73 46 0.06 <0.001 22–33 Reversibility to BD 33 23 14.4 <0.001 4–14 Reversibility to steroids 10 4 19.2 <0.001 3–9 Vaccination advice 5 4 1.2 0.27 −1–4 Pulmonary rehabilitation 5 1 23.3 <0.001 3–6 Comparisons made using the chi-squared test for 2×2 tables. Case numbers for inhaler technique and for smoking advice were lower due to exclusions
95% CI: 95% confidence intervals
FEV1: forced expiratory volume in one second
PEF: peak expiratory flow
BD: bronchodilator.
