Characteristics of Patients Experiencing Rehospitalization or Death After Hospital Discharge in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, 2019

Mikosz, Christina A.; Danielson, Melissa L.; Anderson, Kayla N.; Pollack, Lori A.; Currie, Dustin W.; Njai, Rashid; Evans, Mary; Goodman, Alyson B.; Twentyman, Evelyn; Wiltz, Jennifer L.; Rose, Dale A.; Krishnasamy, Vikram; King, Brian A.; Jones, Christopher M.; Briss, Peter A.; Lozier, Matthew; Ellington, Sascha; Adebayo, Adebola; Atti, Sukhshant; Board, Amy; Austin, Chelsea; Chandra, Gyan; Coy, Kelsey; Cyrus, Alissa C.; Fajardo, Geroncio; Goyal, Sonal; Graves, Sierra; Hamilton, Janet; Hayes, Donald K.; Hughes, D. E. R.; Israel, Mia; Ko, Jean Y.; Li, Zheng; Lynfield, Ruth; Newton, Suzanne; Parks, Sharyn E.; Pomeroy, Mary; Roguski, Katherine; Salvatore, Phillip P.; Schrodt, Caroline A.; Soroka, Stephen; Thomas, Kimberly; Wallace, Bailey; Wallace, Megan; Epidemiology, Lung Injury Response; Force, Surveillance Task

doi:10.15585/mmwr.mm685152e1

Cited by 48 publications

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“…Characteristics of EVALI patients who were rehospitalized or died following hospital discharge indicate that some chronic medical conditions, including cardiac disease, chronic pulmonary disease (e.g., chronic obstructive pulmonary disease and obstructive sleep apnea), and diabetes, and increasing age are risk factors leading to higher morbidity and mortality among some EVALI patients. For example, 70.6% of patients who were rehospitalized and 83.3 (five of six) of patients who died had one or more chronic conditions, compared with 25.6% of patients who were neither rehospitalized nor died (9). EVALI patients who were rehospitalized or died after discharge were older: the median ages of patients who died, were rehospitalized, and who neither died nor were rehospitalized were 54, 27, and 23 years, respectively (9).…”

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confidence: 98%

“…For example, 70.6% of patients who were rehospitalized and 83.3 (five of six) of patients who died had one or more chronic conditions, compared with 25.6% of patients who were neither rehospitalized nor died (9). EVALI patients who were rehospitalized or died after discharge were older: the median ages of patients who died, were rehospitalized, and who neither died nor were rehospitalized were 54, 27, and 23 years, respectively (9).…”

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confidence: 98%

“…On December 20, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).…”

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confidence: 99%

“…Clinical guidance from CDC and state partners for EVALI continues to evolve as more information about EVALI becomes available (5)(6)(7)(8). Among EVALI patients who were rehospitalized or who died after discharge for an EVALI-related hospitalization, a recent study found a high rate of comorbidities and a median interval from discharge to readmission of 4 days and a median interval from discharge to death of 3 days; at least one quarter of rehospitalizations and deaths occurred within 2 days of discharge (9). The study findings prompted CDC, in consultation with the Lung Injury Response Clinical Working Group, to update guidance regarding timing of the initial postdischarge follow-up of hospitalized EVALI patients and other EVALI patient management.…”

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confidence: 99%

“…As of December 10, 2019, a total of 2,409 hospitalized EVALI cases have been reported to CDC, including 52 (2%) deaths among EVALI patients. Among 1,139 reported cases with patient hospital discharge by October 31, 2019, 31 (2.7%) patients were rehospitalized after initial discharge (median time to readmission: 4 days [interquartile range: 2-20 days]), and seven patients died following discharge after an EVALI hospitalization (median time to death: 3 days [interquartile range 2-13 days]) (9). Characteristics of EVALI patients who were rehospitalized or died following hospital discharge indicate that some chronic medical conditions, including cardiac disease, chronic pulmonary disease (e.g., chronic obstructive pulmonary disease and obstructive sleep apnea), and diabetes, and increasing age are risk factors leading to higher morbidity and mortality among some EVALI patients.…”

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confidence: 99%

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Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019

Evans¹,

Twentyman²,

Click³

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

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confidence: 98%

mentioning

confidence: 98%

“…On December 20, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019

Evans¹,

Twentyman²,

Click³

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

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Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) in the United States in 2019

et al. 2020

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IMPORTANCETo date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI).OBJECTIVE To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults. DESIGN, SETTING, AND PARTICIPANTSSurveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155). MAIN OUTCOMES AND MEASURES Demographics, substance use behaviors, and clinical characteristics.RESULTS Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI,. A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided.CONCLUSIONS AND RELEVANCE Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is rec...

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E‐cigarette or vaping product use‐associated lung injury (EVALI) features and recognition in the emergency department

et al. 2020

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Since August 2019, the pulmonary disease termed e‐cigarette or vaping product‐use associated lung injury (EVALI), has resulted in 2758 hospitalizations and 64 deaths in the United States. EVALI is considered in patients who have vaped or dabbed within 90 days of symptom onset, and have abnormal lung imaging in the absence of any pulmonary infection. The majority of EVALI patients are otherwise healthy adolescents and young adults. The leading etiology of EVALI is contamination of delta‐9‐tetrahydrocannabinoid (THC) e‐liquids with vitamin E acetate. Although the exact pathophysiology of vitamin E acetate‐induced lung injury is unknown, vitamin E acetate may lead to pulmonary lipid accumulation and/or interfere with surfactant functioning. EVALI symptoms are vague but consist of a constellation of constitutional, pulmonary, and gastrointestinal symptoms. Patients often present multiple times to healthcare facilities as their clinical condition worsens with a considerable mortality risk. The diagnosis of EVALI hinges on obtaining history leading to the recognition of vaping/dabbing. Physicians need to be persistent, but nonjudgmental, in obtaining vaping histories, especially in THC‐prohibited states. Radiographical findings of nonspecific bilateral ground‐glass infiltrates are best detected on computed tomography. Management for EVALI requires a multidisciplinary approach focused on supportive respiratory care and ruling‐out infectious causes. Corticosteroids may be of benefit. Most patients who are hypoxic, have comorbidities, or lack appropriate follow‐up within 24–48 hours should be admitted for monitoring. Patients may benefit from substance abuse counseling and should be instructed to avoid vaping. As the outbreak continues, cases should be reported to local health departments and poison control centers.

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Characteristics of Patients Experiencing Rehospitalization or Death After Hospital Discharge in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, 2019

Cited by 48 publications

References 11 publications

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019

Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) in the United States in 2019

E‐cigarette or vaping product use‐associated lung injury (EVALI) features and recognition in the emergency department

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