title: Appropriateness of diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation.
abstract: OBJECTIVE
  To assess the adequacy of diagnostic effort in the emergency departments of Spanish hospitals with respect to episodes of exacerbation of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A descriptive cross-sectional study, conducted between 2007 and 2010 in 15 hospitals in Andalusia, Catalonia, Madrid and the Basque Country. The study population included cases of COPD exacerbation attended at the emergency departments of the participating hospitals. Diagnostic efforts were considered sufficient and appropriate when the emergency room conducted a clinical evaluation including electrocardiogram, chest X-ray, arterial blood gas analysis and spirometry.
  
  
  RESULTS
  2852 episodes of COPD exacerbation attended in hospital emergency departments were assessed. 91.4% of the patients were male, with a mean age of 72.8 (SD 9.5) years, and 45.6% had had a previous emergency admission. The diagnostic effort was considered adequate in 60.1% of the episodes (95% CI: 58.3-61.9). The inter-hospital range of variation(25-75) was 1.67 and the coefficient of variation was 28.3%. In multivariate analysis, adjusting for hospital, date of admission and previous hospitalization, among the male patients, the OR for adequate diagnostic effort was 1.38 (95% CI: 1.04-1.84) CONCLUSION: With respect to diagnostic effort, inequities were observed in our assessment of episodes of COPD exacerbation attended in the emergency departments of Spanish public hospitals. In a high percentage of cases (40%), proper assessment was not conducted. Moreover, inter-individual and inter-hospital differences were observed.
authors.affiliation: Agencia Sanitaria Costa del Sol, Unidad de Investigación, Marbella, Spain.|Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.affiliation: Agencia Sanitaria Costa del Sol, Unidad de Investigación, Marbella, Spain.|Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Maximino
authors.initials: M
authors.lastname: Redondo
authors.affiliation: Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad de Investigación, Hospital Galdakao-Usansolo, Vizcaya, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: González
authors.affiliation: Agencia Sanitaria Costa del Sol, Unidad de Investigación, Marbella, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vidal
authors.affiliation: Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad de Investigación, Hospital Galdakao-Usansolo, Vizcaya, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: García
authors.affiliation: Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad de Investigación, Hospital Galdakao-Usansolo, Vizcaya, Spain.
authors.forename: Iratxe
authors.initials: I
authors.lastname: Lafuente
authors.affiliation: Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad de Investigación, Hospital Galdakao-Usansolo, Vizcaya, Spain.|Corporaciò Parc Taulí, Unidad de Epidemiología Clínica, Barcelona, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Bare
authors.affiliation: Servicio de Neumología, Hospital de Torrejón, Madrid, Spain.
authors.forename: María del Puerto
authors.initials: Mdel P
authors.lastname: Cano Aguirre
authors.affiliation: Red Nacional de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad de Investigación, Hospital Galdakao-Usansolo, Vizcaya, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Quintana-López
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D013030:Spain
keywords: chronic obstructive pulmonary disease; diagnostic techniques; emergency service; health services research; variability