title: Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To develop detailed, explicit criteria for determining the appropriateness of admission for patients with exacerbations of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Using a modified Delphi process, a panel of seven pneumologists and five emergency department (ED) physicians was assembled to establish the appropriateness of hospital admission for 896 distinct theoretical scenarios. To assess the reliability of the criteria, a second national panel of five pneumologists and five ED physicians was assembled. We examined the influence of all variables on the first panel score using linear regression models. The explicit criteria developed were summarised by classification and regression tree analysis.
  
  
  RESULTS
  The appropriateness of the hospitalisation scenarios increased with the severity of COPD. The kappa of agreement between the two panels was 0.79. Predictors of appropriate hospitalisation were severity of current COPD exacerbation, response to previous treatment and expected adherence to treatment. The panel results were synthesised and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel's original ratings, was 6.1%.
  
  
  CONCLUSIONS
  These explicit criteria can be used to help determine the appropriateness of admission for patients with exacerbations of COPD.
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Consortio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Galdakao, Vizcaya, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.forename: J M
authors.initials: JM
authors.lastname: Quintana
authors.forename: U
authors.initials: U
authors.lastname: Aguirre
authors.forename: C
authors.initials: C
authors.lastname: Esteban
authors.forename: A
authors.initials: A
authors.lastname: Bilbao
authors.forename: A
authors.initials: A
authors.lastname: Escobar
authors.forename: S
authors.initials: S
authors.lastname: Vidal
authors.forename: M
authors.initials: M
authors.lastname: Bare
authors.forename: F
authors.initials: F
authors.lastname: Aizpuru
authors.forename: J A
authors.initials: JA
authors.lastname: Blasco
mesh_terms: D003663:Decision Trees; D003697:Delphi Technique; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D010349:Patient Compliance; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000628:therapy; D015203:Reproducibility of Results; D012720:Severity of Illness Index