Summary
Development of a severity scale for acute exacerbation of chronic obstructive pulmonary disease in hospital emergency departments
García-Gutiérrez S, Quintana JM, Unzurrunzaga A, Esteban C, González N, Barrio I, Pulido E, Bare ML, Andueza Lillo JA
Affiliation of the authors
Unidad de Investigación, Servicio de Neumología, Hospital Galdakao-Usansolo, Vizcaya, Spain. Universidad del País Vasco, Departamento de Matemáticas, Vizcaya, Spain. Servicio de Urgencias, Hospital Galdakao-Usansolo, Vizcaya, Spain. Servicio de Epidemiología Clínica, Hospital Parc Taulí, Barcelona, Spain. Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, Spain.
DOI
Quote
García-Gutiérrez S, Quintana JM, Unzurrunzaga A, Esteban C, González N, Barrio I, et al. Development of a severity scale for acute exacerbation of chronic obstructive pulmonary disease in hospital emergency departments. Emergencias. 2014;26:251-8
Summary
Objectives: To develop and validate a simple scale for assessing the severity of acute
exacerbation of chronic obstructive pulmonary disease (AECOPD).
Methods: Prospective study of a cohort of consecutive patients who came to the
hospital emergency department with symptoms consistent with AECOPD. Clinical and
sociodemographic data were recorded. The main endpoint was poor clinical course, a
composite that included 1) in-hospital exitus in hospitalized patients or death with 1
week of the visit in discharged patients; 2) admission to the intensive care unit; 3) need
for invasive mechanical ventilation; 4) cardiorespiratory arrest; 5) use of noninvasive
mechanical ventilation and/or admission to an intermediate respiratory care unit.
Independent predictors of the endpoint were identified by logistic regression and
incorporated into a clinical risk prediction scale. The scale was validated in a subsample
and in bootstrap subsamples.
Results: A total of 2487 patients with AECOPD were included. The mean (SD) age was
72.8 (9.7) years; 91.3% were men. The mean forced expiratory volume in 1 second was
45.2% (16.8%) of predicted; 61.8% of the patients were admitted and clinical course
was poor in 7.8%. The 3 predictors of poor course were arterial blood pH, PaCO2, and
paradoxical breathing (accessory muscle recruitment) on arrival in the department. The
area under the receiver operating characteristics curve for the model was 0.8 (95% CI,
0.8-0.9); the model’s ability to indentify cases of poor clinical course (discrimination) was
excellent.
Conclusion: This AECOPD severity scale predicts poor clinical course and could be used
as an aid to decision-making when attending emergency patients.