Hospitalizations and return visits after chronic obstructive pulmonary disease ED visits

Published:August 05, 2013DOI:



      The aim of this study was to describe population-based patterns of chronic obstructive pulmonary disease (COPD)–related emergency department (ED) visits.


      We analyzed all COPD-related ED visits made by North Carolina residents 45 years or older in 2008 to 2009 using statewide surveillance system data. Return visits were identified when patients returned to the same ED within 3 or 14 days of a prior COPD-related visit. We quantify the prevalence of hospitalization and return visits by age, sex, and payment method and describe ED disposition patterns.


      Nearly half (46.3%) of the 97 511 COPD-related ED visits resulted in hospital admission. The percent of visits preceded by another COPD-related visit within 3 and 14 days was 1.6% and 6.2%, respectively. Emergency department–related hospitalizations increased with age; there were no differences by sex. Hospitalizations were less likely for uninsured, Medicare, and Medicaid visits than for privately insured visits. In contrast, 3- and 14-day return visits were more likely to be uninsured, Medicare, and Medicaid visits than privately insured visits. Fourteen-day returns were more likely to be made by men. Return visits initially increased with age compared with the 45- to 49-year age group, then decreased steadily after age 65 years. When return visits were made, discharge at both visits was the most common disposition pattern. However, 33.7% of 3-day returns and 22.7% of 14-day returns were discharged at the first visit and hospitalized upon returning to the ED.


      Chronic obstructive pulmonary disease–related hospital admissions and short-term return ED visits were common and varied by age and insurance status. Chronic obstructive pulmonary disease management remains a critical area for intervention and quality improvement.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Chronic obstructive pulmonary disease among adults—United States.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 938-943
      2. Elixhauser A, Au DH, Podulka J. Readmissions for chronic obstructive pulmonary disease, 2008 [Internet]. Rockville, MD: Agency for Health Care Research and Quality (US); 2011 Sep. Report No.: #121. Available at:

        • Brown D.W.
        • Pleasants R.
        • Ohar J.A.
        • Kraft M.
        • Donohue J.F.
        • Mannino D.M.
        • et al.
        Health-related quality of life and chronic obstructive pulmonary disease in North Carolina.
        N Am J Med Sci. 2010; 2: 60-65
        • Mannino D.M.
        • Braman S.
        The epidemiology and economics of chronic obstructive pulmonary disease.
        Proc Am Thorac Soc. 2007; 4: 502-506
        • Rowe B.H.
        • Voaklander D.C.
        • Marrie T.J.
        • Senthilselvan A.
        • Klassen T.P.
        • Rosychuk R.J.
        Outcomes following chronic obstructive pulmonary disease presentations to emergency departments in Alberta: a population-based study.
        Can Respir J. 2010; 17: 295
        • Tsai C.-L.
        • Clark S.
        • Cydulka R.K.
        • Rowe B.H.
        • Camargo C.A.
        Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation.
        Acad Emerg Med. 2007; 14: 6-14
        • Kim S.
        • Emerman C.L.
        • Cydulka R.K.
        • Rowe B.H.
        • Clark S.
        • Camargo C.A.
        Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation.
        Chest. 2004; 125: 473-481
        • Soler-Cataluña J.J.
        • Rodriguez-Roisin R.
        Frequent chronic obstructive pulmonary disease exacerbators: how much real, how much fictitious?.
        COPD: Journal of Chronic Obstructive Pulmonary Disease. 2010; 7: 276-284
        • Horwitz L.
        • Partovian C.
        • Lin Z.
        • Herrin J.
        • Grady J.
        • Conover M.
        • et al.
        Hospital-wide (all-condition) 30-day risk-standardized readmission measure [Internet].
        (Available from:)
        • Yeatts K.
        • Lippmann S.J.
        • Waller A.
        • Hassmiller Lich K.
        • Travers D.
        • Weinberger M.
        • et al.
        Population-based burden of COPD-related visits in the emergency department (ED): return ED visits, hospital admissions, and comorbidity risks.
        CHEST [Internet]. 2013; (Accessed April 15, 2013; Available at:)
      3. Carolina Center for Health Informatics, University of North Carolina at Chapel Hill. The UNC Department of Emergency Medicine Carolina Center for Health Informatics Report, NC DETECT Emergency Department Data: 2008 [Internet]. 2010. Available from:

        • Rowe B.H.
        • Villa-Roel C.
        • Guttman A.
        • Ross S.
        • Mackey D.
        • Sivilotti M.L.A.
        • et al.
        Predictors of hospital admission for chronic obstructive pulmonary disease exacerbations in Canadian emergency departments.
        Acad Emerg Med. 2009; 16: 316-324
        • Yip N.H.
        • Yuen G.
        • Lazar E.J.
        • Regan B.K.
        • Brinson M.D.
        • Taylor B.
        • et al.
        Analysis of hospitalizations for COPD exacerbation: opportunities for improving care.
        COPD: Journal of Chronic Obstructive Pulmonary Disease. 2010 Apr; 7: 85-92
        • Vestbo J.
        • Hurd S.S.
        • Agustí A.G.
        • Jones P.W.
        • Vogelmeier C.
        • Anzueto A.
        • et al.
        Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease GOLD executive summary.
        Am J Respir Crit Care Med. 2013; 187: 347-365
        • U.S. Census Bureau
        North Carolina QuickFacts from the US Census Bureau [Internet].
        (Accessed March 13, 2013. Available at:)
        • Centers for Disease Control, Prevention
        CDC—STATE System: Highlights Report—"rlinet1tbl15North Carolina [Internet].
        (Accessed March 13, 2013. Available at:)