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Canadian Journal of Public Health

, Volume 91, Issue 2, pp 107–112 | Cite as

Beyond Administrative Data: Characterizing Cardiorespiratory Disease Episodes Among Patients Visiting the Emergency Department

  • David M. StiebEmail author
  • Robert C. Beveridge
  • Marc Smith-Doiron
  • Richard T. Burnett
  • Stan Judek
  • Robert E. Dales
  • Aslam H. Anis
Article

Abstract

We attempted to address deficiencies in administrative health service data during a study of cardiorespiratory emergency department visits. From 1994–1996, we obtained data on 9,264 visits and conducted 1,772 follow-up interviews. The median interval between symptoms and visit ranged from 0.8 days (95% CI 0–1.7) for cardiac conditions to 4.0 days for chronic obstructive pulmonary disease (COPD) (95% CI 2.7–5.3) and respiratory infections (95% CI 3.5–4.5). Infection was the most common trigger of respiratory visits. Although most had improved at follow-up, symptoms persisted following the visit for a mean of 4.5 days (95% CI 3.8–5.4) for cardiac conditions to 8.4 days (95% CI 7.2–9.5) for COPD. Among adults aged <70, the mean number of reduced activity days per episode ranged from 4.7 (95% CI 3.9–5.4) for asthma to 6.6 (95% CI 5.9–7.4) for respiratory infections. Our data assist in interpreting epidemiological studies based on administrative data, and illustrate the broad impacts of cardiorespiratory disease episodes.

Résumé

Nous avons tenté de compenser le manque de données administratives sur l’utilisation des services de santé au cours d’une étude sur les visites à l’urgence pour des problèmes cardiorespiratoires. De 1994 à 1996, nous avons recueilli des données sur 9 264 visites et procédé à 1 772 entrevues de suivi. L’intervalle médian entre l’apparition des symptômes et la visite s’étendait de 0,8 jour pour les problèmes cardiaques (IC de 95 %, de 0 à 1,7) à 4,0 jours pour les cas de bronchopneumopathie chronique obstructive (BCO) (IC de 95 %, de 2,7 à 5,3) et les infections respiratoires (IC de 95 %, de 3,5 à 4,5). L’infection est apparue comme le facteur le plus commun à l’origine d’une visite pour problème respiratoire. Même si lors du contrôle de suivi, la plupart des cas s’étaient améliorés, les symptômes persistaient en moyenne de 4,5 jours après la visite pour les problèmes cardiaques (IC de 95 %, de 3,8 à 5,4) à 8,4 jours (IC de 95 %, de 7,2 à 9,5) pour les cas de BCO. Chez les adultes de moins de 70 ans, le nombre moyen de jours d’activités réduites par épisode variait de 4,7 (IC de 95 %, de 3,9 à 5,4) pour l’asthme à 6,6 (IC de 95 %, de 5,9 à 7,4) pour les infections respiratoires. Nos données aident à interpréter les études épidémiologiques fondées sur des données administratives, et illustrent le vaste impact des épisodes de maladies cardiorespiratoires.

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References

  1. 1.
    Vollmer WM, Osborne ML, Buist, AS. Uses and limitations of mortality and health care utilization statistics in asthma research. Am J Respir Crit Care Med 1994;149:S79-S87.CrossRefGoogle Scholar
  2. 2.
    Stieb DM, Beveridge RC, Brook JR, et al. The Saint John Particle Health Effects Study. Measuring Health Effects, Health Costs and Quality of Life Impacts Using Enhanced Administrative Data: Design and Preliminary Results. In. Particulate Matter: Health and Regulatory Issues (VIP-49), Proceedings of an International Specialty Conference, 4–6 April 1995, Pittsburgh, PA. Pittsburgh: Air and Waste Management Association, 1995.Google Scholar
  3. 3.
    Burnett RT, Dales RE, Raizenne ME, et al. Effects of low ambient levels of ozone and sulfates on the frequency of respiratory admissions to Ontario hospitals. Environ Res 1994;65:172–94.CrossRefGoogle Scholar
  4. 4.
    Burnett RT, Dales R, Krewski D, et al. Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. Am J Epidemiol 1995;142:15–22.CrossRefGoogle Scholar
  5. 5.
    Dales RE, Kerr PE, Schweitzer I, et al. Asthma management preceding an emergency department visit. Arch Intern Med 1992;152:2041–44.CrossRefGoogle Scholar
  6. 6.
    Boulet L-P, Bélanger M, Lajoie P. Characteristics of subjects with a high frequency of emergency visits for asthma. Am J Emerg Med 1996;14:623–28.CrossRefGoogle Scholar
  7. 7.
    Dales RE, Schweitzer I, Kerr P, et al. Risk factors for recurrent emergency department visits for asthma. Thorax 1995;50:520–24.CrossRefGoogle Scholar
  8. 8.
    Chilmonczyk BA, Salmun LM, Megathlin KN, et al. Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. N Engl J Med 1993;328:1665–69.CrossRefGoogle Scholar
  9. 9.
    Emerman CL, Cydulka, RK. Factors associated with relapse after emergency department treatment for acute asthma. Ann Emerg Med 1995;26:6–11.CrossRefGoogle Scholar
  10. 10.
    Bailey WC, Richards JM, Manzella BA, et al. Characteristics and correlates of asthma in a university clinic population. Chest 1990;98:821–28.CrossRefGoogle Scholar
  11. 11.
    Ducharme FM, Kramer, MS. Relapse following emergency treatment for acute asthma: Can it be predicted or prevented? J Clin Epidemiol 1993;46:1395–402.CrossRefGoogle Scholar
  12. 12.
    Chanteloup RE, Beveridge, RC. Smoking in Saint John: A Social and Demographic Profile. Saint John: University of New Brunswick, Saint John and Region II Hospital Corporation, 1993;2.Google Scholar
  13. 13.
    Reed S, Diggle S, Cushley MJ, et al. Assessment and management of asthma in an accident and emergency department. Thorax 1985;40:897–902.CrossRefGoogle Scholar
  14. 14.
    O’Halloran SM, Heaf, DP. Accident and emergency department attendance by asthmatic children. Thorax 1989;44:700–5.CrossRefGoogle Scholar
  15. 15.
    Carlsen KH, Ørstavik I, Leegaard J, et al. Respiratory virus infections and aeroallergens in acute bronchial asthma. Arch Dis Child 1984;59:310–15.CrossRefGoogle Scholar
  16. 16.
    Sokhandan M, McFadden ER, Huang YT, et al. The contribution of respiratory viruses to severe exacerbations of asthma in adults. Chest 1995;107:1570–74.CrossRefGoogle Scholar
  17. 17.
    Roback MG, Baskin, MN. Failure of oxygen saturation and clinical assessment to predict which patients with bronchiolitis discharged from the emergency department will return requiring admission. Pediatr Emerg Care 1997;13:9–11.CrossRefGoogle Scholar
  18. 18.
    Lee, TH. Effective reperfusion for acute myocardial infarction begins with effective health policy. Ann Intern Med 1997;126:652–53.CrossRefGoogle Scholar
  19. 19.
    Heriot AG, Brecker SJ, Coltart, DJ. Delay in presentation after myocardial infarction. J R Soc Med 1993;86:642–44.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Chidley KE, Wood-Baker R, Town GI, et al. Reassessment of asthma management in an accident and emergency department. Respir Med 1991;85:373–77.CrossRefGoogle Scholar
  21. 21.
    Fitzgerald JM, Hargreave, FE. Acute asthma: Emergency department management and prospective evaluation of outcome. CMAJ 1990;142:591–95.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Canny GJ, Reisman J, Healy R, et al. Acute asthma: Observations regarding the management of a pediatric emergency room. Pediatrics 1989;83:507–12.PubMedGoogle Scholar
  23. 23.
    Leech JA, Wilby K, McMullen E, et al. The Canadian Human Activity Pattern Survey: Report of methods and population surveyed. Chron Dis Can 1996;17:118–23.Google Scholar
  24. 24.
    Stieb DM, Brook JR, Broder I, et al. Personal exposure of adults with cardiorespiratory disease to particulate acid and sulphate in Saint John, New Brunswick Canada. Appl Occup Environ Hyg 1998;13:461–68.CrossRefGoogle Scholar
  25. 25.
    Ernst P, Fitzgerald JM, Spier S. Canadian Asthma Consensus Conference: Summary of recommendations. Can Respir J 1996;3:89–100.CrossRefGoogle Scholar
  26. 26.
    Stein LM, Cole, RP. Early administration of corticosteroids in emergency room treatment of acute asthma. Ann Intern Med 1990;112:822–27.CrossRefGoogle Scholar
  27. 27.
    Chapman KR, Verbeek PR, White JG, et al. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med 1991;324:788–94.CrossRefGoogle Scholar
  28. 28.
    Murata GH, Gorby MS, Kapsner CO, et al. A multivariate model for the prediction of relapse after outpatient treatment of decompensated chronic obstructive pulmonary disease. Arch Intern Med 1992;152:73–77.CrossRefGoogle Scholar
  29. 29.
    Murata GH, Gorby MS, Kapsner CO, et al. A multivariate model for predicting hospital admissions for patients with decompensated chronic obstructive pulmonary disease. Arch Intern Med 1992;152:82–86.CrossRefGoogle Scholar
  30. 30.
    Anis AH, Guh D, Stieb DM, et al. The costs of cardiorespiratory disease episodes in a study of emergency department use. Can J Public Health 2000;91(2):103–6.PubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2000

Authors and Affiliations

  • David M. Stieb
    • 1
    Email author
  • Robert C. Beveridge
    • 2
  • Marc Smith-Doiron
    • 1
  • Richard T. Burnett
    • 1
  • Stan Judek
    • 1
  • Robert E. Dales
    • 1
  • Aslam H. Anis
    • 3
  1. 1.Air Quality Health Effects Research SectionHealth CanadaOttawaCanada
  2. 2.Department of Emergency MedicineAtlantic Health Sciences CorporationCanada
  3. 3.Department of Health Care and EpidemiologyUniversity of British ColumbiaCanada

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