title: Predictors of hospital admission in exacerbations of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To identify factors predictive of hospital admission among patients attending an emergency department (ED) with exacerbation of chronic obstructive pulmonary disease (COPD) and to determine if these were consistent with Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations.
  
  
  METHODS
  In a prospective cohort of 2487 COPD patients with exacerbations conducted in 16 EDs, clinical data were obtained and physical examination and blood gas analyses were performed on arrival at the ED and at decision time about hospitalisation. Multivariate analyses were performed using hospital admission as the dependent measure.
  
  
  RESULTS
  In multivariate analysis, factors predictive of hospital admission on ED arrival were previous hospitalisation for COPD exacerbation (OR 2.03, 95%CI 1.32-3.11), resting dyspnoea (OR 3.05, 95%CI 2.39-3.88) and altered blood gas (PaO2 = 45-60 mmHg, OR 2.7, 95%CI 2.12-3.44; PaO2 < 45 mmHg, OR 3.24, 95%CI 2.14-4.92; PaCO2 = 56-65 mmHg, OR 2.35, 95%CI 1.58-3.51; and PaCO2 > 65 mmHg, OR 6.98, 95%CI 4.03-12.09). The predictive capacity of the model using variables available at decision time was better than for those at ED arrival (area under the receiver operating characteristic curve 0.89 and 0.83). These factors are included in the GOLD recommendations.
  
  
  CONCLUSIONS
  Among COPD patients presenting to the ED with exacerbation, factors immediately associated with episode severity were independent predictors of hospitalisation. Our criteria for hospitalisation are in line with GOLD recommendations.
authors.affiliation: Unidad de Investigación, Hospital Costa del Sol, Marbella, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Vidal
authors.forename: N
authors.initials: N
authors.lastname: González
authors.forename: I
authors.initials: I
authors.lastname: Barrio
authors.forename: F
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.forename: M
authors.initials: M
authors.lastname: Baré
authors.forename: J A
authors.initials: JA
authors.lastname: Blasco
authors.forename: C
authors.initials: C
authors.lastname: Ruíz-Frutos
authors.forename: J M
authors.initials: JM
authors.lastname: Quintana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain