Clinical Audit of Patients Hospitalized due to COPD Exacerbation. MAG-1 Study

Escarrabill, Joan; Torrente, Elena; Esquinas, Cristina; Hernández, Carme; Monsó, Eduard; Freixas, Montserrat; Almagro, Pere; Tresserras, Ricard

doi:10.1016/j.arbr.2015.04.008

Cited by 25 publications

(23 citation statements)

References 31 publications

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“…5 Additionally, our population was very similar in terms of sex, age, and length of stay to that reported in prospective cohort studies conducted in the same area. 10,45 In conclusion, our study demonstrates an independent relationship between ambient temperature and the number of hospital admissions for COPD exacerbation even after adjustment for humidity, comorbidity, influenza syndromes, and air pollution.…”

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confidence: 55%

Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area

Almagro¹,

Hernández²,

Martinez-Cambor³

et al. 2015

COPD

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BackgroundExcluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD.MethodsThis was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied.ResultsA total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r2=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r2=0.599, P<0.001).ConclusionMean temperatures are closely and independently related to the number of hospitalizations for COPD.

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confidence: 55%

Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area

Almagro¹,

Hernández²,

Martinez-Cambor³

et al. 2015

COPD

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“…In either case, it can be concluded that VCF acts as a biomarker of poor prognosis in hospitalized ECOPD patients. However, and surprisingly, in most of the previous studies, spinal fractures have not been considered as an important element associated with morbidity and mortality in ECOPD patients, at least as an individual factor differentiated from other comorbidities 20,21. In other words, only very few previous studies have specifically examined the impact of the presence of VCF in the prognosis of COPD patients.…”

Section: Discussionmentioning

confidence: 99%

Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures

Pascual-Guardia¹,

Badenes-Bonet²,

Martín-Ontiyuelo³

et al. 2017

COPD

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BackgroundVertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known.ObjectiveTo assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF.MethodsClinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers).ResultsFrom the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, P<0.01; 12 [6–30] vs 9 [6–18] days, P<0.05; and 50 vs 32.1% deaths, P<0.01, respectively). The risk of dying in the two following years was also higher in VCF patients (odds ratio: 2.11 [1.2–3.6], P<0.01). The validation cohort consisted of 250 patients who showed very similar results. The logistic regression analysis indicated that both VCF and age were factors independently associated with mortality.ConclusionAlthough VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.

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“…Other common themes include suboptimal NIV practice and ABG monitoring, excess oxygen therapy, high antibiotic prescription and reduced vaccination recommendations . Compared with some studies, a larger proportion (76.9%) of our patients had a spirometry result at baseline . Whereas investigators from Spain found all their discharge summaries for current smokers contained cessation recommendations, this was only done in two of our cases .…”

Section: Discussionmentioning

confidence: 56%

“…A multinational European study found that oxygen therapy and non‐invasive ventilation (NIV) were delivered without meeting arterial blood gas (ABG) criteria, while a Swiss study reported suboptimal referrals for pulmonary rehabilitation and assessment of influenza vaccination status . Several other studies described a lack of spirometric confirmation of COPD …”

Section: Introductionmentioning

confidence: 99%

Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital

Sha

Worsnop

Leaver

et al. 2020

Internal Medicine Journal

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Background: Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD-X Plan, provide evidence-based recommendations, but adherence in hospital practice is variable.Aims: To examine current practice in management of COPD exacerbations at an Australian teaching hospital and to compare with COPD-X Plan recommendations.Methods: Data were collected retrospectively from electronic medical records for admissions occurring during 1 May to 31 August 2016, and compared with recommendations from the COPD-X Plan.Results: A total of 134 patients (n = 68 females) was admitted for a COPD exacerbation during the study period. Mean age was 75.4 AE 10.2 years and 33.6% were current smokers. Airflow obstruction on spirometry was confirmed in 67.2% (mean forced expiratory volume in 1 s was 53 AE 22% predicted (1.2 AE 0.5 L)). Excellent adherence to the COPD-X Plan was demonstrated in the ordering of chest radiographs (97%) and electrocardiograms (94%). Supplemental oxygen was appropriately provided to all patients with oxygen saturation of <88%. All patients with confirmed hypercapnic respiratory failure were managed with non-invasive ventilation. Corticosteroids and bronchodilators were prescribed for the majority of patients. Areas of suboptimal practice included inadequate usage of arterial blood gases, excess supplemental oxygen in the absence of hypoxaemia, over-prescription of intravenous antimicrobials, low referral rates to pulmonary rehabilitation and insufficient smoking cessation counselling.Conclusions: Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice.

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Clinical Audit of Patients Hospitalized due to COPD Exacerbation. MAG-1 Study

Cited by 25 publications

References 31 publications

Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area

Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area

Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures

Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital

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