title: Prognostic severity scores for patients with COPD exacerbations attending emergency departments.
abstract: METHODS
  Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations (eCOPD) are various and inconsistent in the bibliography.
  
  
  OBJECTIVE
  To develop clinical prediction rules for short-term outcomes in eCOPD patients attending an emergency department (ED).
  
  
  METHODS
  Prospective cohort study of patients with an eCOPD. Short-term outcomes were admission to an intensive care unit (ICU), admission to an intermediate respiratory care unit (IRCU) and death in these groups. Multivariate logistic regression models were developed for each of the outcomes.
  
  
  RESULTS
  Predictors of ICU or IRCU admission were use of long-term home oxygen therapy (LT-HOT) or non-invasive mechanical ventilation (NIMV), elevated PCO2 and decreased pH upon ED arrival (area under the curve [AUC] 0.87 in the derivation sample; 0.89 in the validation sample). Among those admitted to an ICU or IRCU, predictors of death were increased age, use at home of LT-HOT or NIMV, use of inspiratory accessory muscles upon ED arrival and altered Glasgow Coma Scale (<15 points) (AUC 0.78).
  
  
  CONCLUSIONS
  Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among eCOPD patients. Such a score can be a tool for clinical practice.
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bizkaia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Unzurrunzaga
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Gonzalez
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Lafuente
authors.affiliation: Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bizkaia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bare
authors.affiliation: Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bizkaia, Spain.
authors.forename: N Fernandez
authors.initials: NF
authors.lastname: de Larrea
authors.affiliation: Unidad de Calidad, Hospital Valme, Sevilla, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Vidal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012372:ROC Curve; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors