title: Clinical audit on diagnostic accuracy and management of respiratory failure in COPD.
abstract: BACKGROUND
  The aim of the study was to evaluate the adequacy of diagnosis and management of respiratory failure (RF) in COPD.
  
  
  METHODS
  Retrospective analysis of the hospital discharge forms of COPD patients hospitalized for RF from January 2007 to June 2008. Using the clinical audit tool, the primary end point was the accuracy of RF diagnosis. The secondary end points were mortality, re-hospitalization rate, length of hospital stay, accuracy of long-term oxygen therapy (LTOT) prescription, and agreement of the treatments with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2008 guidelines. Statistical analysis used Pearson and Spearman correlation test and the Cohen kappa for degree of agreement. Differences in demographics and clinical parameters were analyzed with the chi-square test, t test, or the Fisher test, as appropriate.
  
  
  RESULTS
  We studied 130 patients, 81 males (62%), mean ± SD age 76.6 ± 9.1 years. Arterial blood gas analysis (ABG) was performed in 118 patients (90.8%), and in 77 (81%) a P(aO(2)) < 60 mm Hg was found at admission. Of these, 42 cases (54.5%) had no diagnosis of RF, despite a P(aO(2)) < 60 mm Hg. In 18 (19%) P(aO(2)) was ≥ 60 mm Hg; of these, 6 cases (33.3%) received an incorrect RF diagnosis. At discharge 8.1% of patients did not receive a diagnosis of RF, despite a compatible ABG. The highest mortality was found in the medicine departments (14.7%). The re-hospitalization rate at 90 days was 19.5%. Adherence of the treatment to the GOLD guidelines during hospitalization was confirmed in 75.8% of patients. In 41.1% of cases LTOT was prescribed at discharge; in 24 out of 27 cases P(aO(2)) values were < 55 mm Hg.
  
  
  CONCLUSIONS
  Agreement between diagnosis of RF and ABG values was found to be insufficient in about half the cases. Among secondary end points, adherence of the treatment to guidelines and LTOT prescription were, however, found to be good. Data showed significant inaccuracies in the management of RF at our institution.
authors.affiliation: Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Menzella
authors.forename: Nicola
authors.initials: N
authors.lastname: Facciolongo
authors.forename: Mirco
authors.initials: M
authors.lastname: Lusuardi
authors.forename: Roberto
authors.initials: R
authors.lastname: Piro
authors.forename: Debora
authors.initials: D
authors.lastname: Formisano
authors.forename: Claudia
authors.initials: C
authors.lastname: Castagnetti
authors.forename: Anna
authors.initials: A
authors.lastname: Simonazzi
authors.forename: Luigi
authors.initials: L
authors.lastname: Zucchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D010102:Oxygen Inhalation Therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies