Updates: Characteristics of Patients Experiencing Rehospitalization or Death after Hospital Discharge in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI); and Interim Guidance for Health Care Professionals Caring for Patients with Suspected EVALI and Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, 2019


MMWR Early Release / December 20, 2019

Summary

Dear COCA Partners and Subscribers, we would like to notify you of two newly released Morbidity and Mortality Weekly Reports (MMWRs) on the topic of EVALI.

 
The first report, Characteristics of Patients Experiencing Rehospitalization or Death after Hospital Discharge in a National Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury — United States, 2019, describes the characteristics of patients who experience rehospitalization or death after hospital discharge. 


A complementary report, Interim Guidance for Health Care Professionals Caring for Patients with Suspected EVALI and Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, 2019, released simultaneously, provides updated clinical guidance for patient management, discharge planning, and follow-up care for hospitalized patients to minimize the risk of readmission or death.

Background

The Centers for Disease Control and Prevention, the Food and Drug Administration, state and local health departments, and public health and clinical stakeholders continue to investigate a nationwide outbreak of e-cigarette, or vaping, product use–associated lung injury. EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment.

Recommendations for Clinicians and Public Health

These reports contain updated guidance to clinicians and offer new recommendations and tools to support health care providers before and during hospital discharge to minimize the risk of rehospitalization or death.

Incorporating these updated recommendations into the management of patients with EVALI may minimize risk of rehospitalization and avert further mortality among patients hospitalized for EVALI. 
  • Patients should be in stable condition for 24–48 hours prior to discharge.
  • Patients should have a follow-up visit with a primary care physician or pulmonary specialist optimally within 48 hours of discharge to minimize the risk of rehospitalization or death. 
  • A high proportion of EVALI patients who were rehospitalized or died after discharge had one or more chronic medical conditions, including cardiac disease, chronic pulmonary disease, and diabetes, and increasing age might be risk factors leading to higher morbidity and mortality among some EVALI patients.
  • Clinicians should expand efforts to enhance care coordination and discharge planning to address comorbidities, including mental health and substance use disorder services.

CDC has created several Resources for Health Care Providers who treat EVALI patients, including an updated algorithm for management of patients with suspected EVALI and an EVALI Discharge Readiness Checklist.


As this investigation continues, CDC encourages clinicians to continue to report possible cases of EVALI to their local or state health department for further investigation.


For further information, please read the complete MMWR reports:


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


MMWR Interim Guidance for Health Care Professionals Caring for Patients with Suspected EVALI and Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, 2019 


In addition, updates, when available, can be found on the CDC Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping page.


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