Validity of criteria for hospital admission in exacerbations of COPD. Issue 7 (20th February 2014)

• Record Type: Journal Article
• Authors: Garcia‐Gutierrez, S.; Quintana, J. M.; Bilbao, A.; Unzurrunzaga, A.; Esteban, C.; Baré, M.; Girón Moreno, R. M.; Pulido, E.; Rivas, P.; IRYSS‐COPD Appropriateness Study (IRYSS‐COPD) Group
• Is Part Of: International journal of clinical practice. Volume 68:Issue 7(2014)
• Page Start: 820
• Page End: 829
• Publication Date: 2014-02-20
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.12397
• Languages: English
• ISSNs: 1368-5031

Abstract

<abstract abstract-type="main" id="ijcp12397-abs-0001"> <title>Summary</title> <sec id="ijcp12397-sec-0001" sec-type="section"> <title>Aims</title> <p>To validate a previously developed set of explicit criteria for the appropriateness of hospital admission among these patients using the RAND/UCLA Appropriateness Methodology (RAM).</p> </sec> <sec id="ijcp12397-sec-0002" sec-type="section"> <title>Methods</title> <p>We conducted a prospective cohort study of patients experiencing symptoms of COPD exacerbation seen in the emergency departments (ED) of 16 hospitals belonging to the Spanish National Health Service. Sociodemographic and clinical variables needed to assess appropriateness were recorded. Main outcomes were mortality, severe COPD evolution, complications at follow up, and three patient‐reported measures: dyspnoea level, capacity for physical activity and perceived health status.</p> </sec> <sec id="ijcp12397-sec-0003" sec-type="section"> <title>Results</title> <p>Appropriately admitted patients were more likely to die (6.70% vs. 2.68%, p = 0.0102) than inappropriately admitted patients, and were more likely to develop severe evolution (27.09% vs. 6.08%, p < 0.0001) and complications (18.72% vs. 11.92%, p = 0.0244). Among discharged patients, no significant differences were observed in clinical outcomes. All patients exhibited worse dyspnoea and capacity for physical activity after exacerbation, but changes among appropriately admitted patients were less than among appropriately discharged patients.</p> </sec> <sec id="ijcp12397-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Our appropriateness criteria identified patients in worse condition at ED arrival who were more likely to benefit from admission in terms of mortality and COPD evolution.</p> </sec> </abstract>