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Citation
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Mikosz CA, Danielson M, Anderson KN, Pollack LA, Currie DW, Njai R, Evans ME, Goodman AB, Twentyman E, Wiltz JL, Rose DA, Krishnasamy V, King BA, Jones CM, Briss P, Lozier M, Ellington S. MMWR Morb. Mortal. Wkly. Rep. 2020; 68(5152): 1183-1188. |
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Abstract
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What is already known about this topic?
Some patients hospitalized for e-cigarette, or vaping, product use–associated lung injury (EVALI) have been rehospitalized or have died after hospital discharge.
What is added by this report?
Compared with other EVALI patients, rehospitalized patients and patients who died after hospital discharge were more likely to have one or more chronic conditions, including cardiac disease, chronic pulmonary disease, and diabetes, and to be older. At least one quarter of rehospitalizations and deaths occurred within 2 days after discharge.
What are the implications for public health practice?
Intensive discharge planning, ensuring clinical stability before discharge, optimized case management, and follow-up optimally within 48 hours after hospital discharge might minimize EVALI patients’ risk for rehospitalization and death, especially among patients with chronic conditions.
As of December 10, 2019, 2.7% of EVALI patients reported to CDC have required rehospitalization, and approximately one in seven deaths among EVALI patients has occurred after discharge. Compared with other hospitalized EVALI patients, the prevalence of one or more chronic conditions was higher among those who required rehospitalization and those who died after discharge. EVALI patients who died also were more likely to have been admitted to an intensive care unit, experienced respiratory failure necessitating intubation and mechanical ventilation, and were significantly older. EVALI patients with chronic comorbidities and these initial hospitalization characteristics might require a higher threshold for hospital discharge and focused efforts during discharge planning and transition to the outpatient setting, such as intensive case management and rapid follow-up (5).
At least one quarter of rehospitalizations occurred within 2 days of initial discharge, which suggests that ensuring clinical stability before discharge as well as postdischarge follow-up optimally within 48 hours might minimize risk for rehospitalization and death, especially among patients with chronic conditions (5). A higher frequency of rehospitalizations among EVALI patients after a longer interval has been reported elsewhere (6); differences observed in the current study might reflect its larger study population and wider geographic distribution of EVALI cases. Concurrent with this report, CDC is publishing additional clinical guidance for discharge planning for EVALI patients (5).
The findings in this report are subject to at least seven limitations. First, the limited proportion of reported cases with detailed clinical data might limit generalizability. Second, the small number of rehospitalizations and deaths after discharge limit the ability to identify significant differences and assess confounding factors. Third, EVALI patients in the comparison group might not fully represent a cohort at lower risk; some patients might still be rehospitalized or die. However, limiting comparison cases to those patients discharged on or before October 31, 2019, was intended to mitigate this effect. Fourth, reported data do not include the reason for rehospitalization or death after hospital discharge of EVALI patients; rehospitalization or death was possibly not related to EVALI, especially among patients with multiple comorbidities. Fifth, use of e-cigarette, or vaping, products, as well as compliance with recommended postdischarge treatment, was not assessed. Sixth, available data might represent an underestimation of rehospitalized EVALI patients. These data might not be as rigorously reported as those concerning patients initially seeking care, there might have been variability in how states defined rehospitalization, or both. Finally, data on insurance status were not collected, so the relationship between EVALI outcomes and insurance status, prescription medication coverage, and access to care in the inpatient and outpatient settings could not be assessed.
Language: en |