Breathlessness intensity recorded in general practice is associated with shorter times to unplanned hospital admissions and longer lengths of stay: a UK cohort study.

IF 3.4 3区 医学 Q1 RESPIRATORY SYSTEM
Urvee Karsanji, Vanessa N Brunelli, Claire A Lawson, Alex Bottle, Magnus Ekström, Irina Kinchin, Slavica Kochovska, Diana Ferreira, Jennifer K Quint, Michael C Steiner, Rachael A Evans, David C Currow
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Abstract

Background and objective: Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of breathlessness limiting exertion (hereafter breathlessness), time between breathlessness recording and subsequent unplanned hospital admissions, and length of stay.

Methods: A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with breathlessness (Medical Research Council (MRC) breathlessness scale; 1-5; 5 is most intense), no pre-existing cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of breathlessness, time to first unplanned admission and hospital length of stay were evaluated, the latter using negative binomial regression.

Results: 103 917 adults had breathlessness scores recorded, of which 16 948 used MRC. 11 911 (70%) adults had a subsequent unplanned hospital admission (median (IQR) of 1538 days (846-2258)) later. More intense breathlessness was associated with higher age, higher body mass index and being a smoker/ex-smoker.Length of time between a first-recorded breathlessness score and the first unplanned hospital admission decreased significantly with higher MRC scores (MRC 1: 1167 days; MRC 5: 615 days).Negative binomial regression showed an association between higher MRC scores and an increased length of inpatient stay (p<0.001; Akaike information criterion=20 817), controlling for key demographic factors.

Conclusion: This is the first study to identify an association between recording breathlessness intensity and time to a person's first unplanned hospital admission and longer inpatient length of stay. Future work must focus on whether interventions can change people's health service use.

Abstract Image

Abstract Image

一项英国队列研究表明,一般情况下记录的呼吸困难强度与意外住院时间较短和住院时间较长有关。
背景和目的:呼吸困难与计划外保健服务使用率较高有关。我们的目的是评估呼吸困难限制运动的严重程度(以下简称呼吸困难)、呼吸困难记录和随后非计划住院之间的时间以及住院时间之间的任何关联。方法:一项回顾性队列研究,对全科医生(英国临床实践研究数据链)中出现呼吸困难的成年人(医学研究委员会(MRC)呼吸困难量表;1 - 5;5是最严重的),没有预先存在的心肺疾病,随后意外住院。使用了2007年至2017年的数据。通过呼吸困难的强度,评估第一次计划外入院的时间和住院时间,后者使用负二项回归。结果:103 917名成年人记录了呼吸困难评分,其中16 948人使用了MRC。11 911名(70%)成年人随后计划外住院(IQR中位数为1538天(846-2258))。更严重的呼吸困难与更高的年龄、更高的身体质量指数以及吸烟者或戒烟者有关。首次记录的呼吸困难评分与首次计划外住院之间的时间长度随着MRC评分的升高而显著减少(MRC 1: 1167天;MRC 5:6 15天)。负二项回归显示较高的MRC评分与延长的住院时间之间存在关联(结论:这是第一个确定记录呼吸困难强度与患者首次计划外住院时间和更长的住院时间之间存在关联的研究。未来的工作必须关注干预措施是否能改变人们对卫生服务的使用。
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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