Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016.

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

<p>Abstract</p> <p>Background</p> <p>Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study.</p> <p>Methods/Design</p> <p>The RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data.</p> <p>Discussion</p> <p>The IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.</p

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Predictors of outcome after exacerbation of chronic obstructive pulmonary disease

BACKGROUND: The outcome after hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD) is unfavorable and uncertainty exists about factors predicting short and long-term prognosis. OBJECTIVE: To identify clinical predictors of length of hospital stay (LOS) and three-year mortality after COPD exacerbations requiring hospitalization. DESIGN: Retrospective analysis of prospectively collected data. PARTICIPANTS AND METHODS: All consecutive patients hospitalized with COPD exacerbation were enrolled. Disease severity was estimated by FEV1, body mass index (BMI), Medical Research Council (MRC) chronic dyspnoea scale, previous hospitalizations, need for long-term oxygen treatment (LTOT), arterial oxygen and carbon dioxide partial pressures (PaO2 and PaCO2), pH and respiratory rate. Outcome was assessed by LOS and three-year mortality. MAIN RESULTS: Out of 81 patients enrolled, three-year mortality data were available for 61. LOS was related to BMI, MRC scale and respiratory rate. Three-year mortality was related to FEV1, BMI, MRC scale, LTOT, and PaCO 2. Multiple logistic regression analysis demonstrated that MRC scale was the only independent determinant of LOS, [p = 0.001, odds ratio (OR) 7.67 (95% CI 2.50-23.41)], whereas MRC scale and BMI predicted three-year mortality, [p = 0.001, OR 8.28 (95% CI 2.25-30.47) and p = 0.006, OR 6.91 (95% CI 1.74-27.48), respectively]. Cox regression analysis demonstrated identical results. Using receiver-operator-optimized thresholds for these variables (MRC &amp;gt; 2 and BMI &amp;lt; 25 kg/m2), we propose a prediction model that accurately determines three-year mortality risk. CONCLUSIONS: In this study, MRC scale and BMI predicted outcome after COPD hospitalization. Pending further validation, this predictive model may contribute to identify patients with poor outcome even when spirometric data are unavailable. © 2009 Society of General Internal Medicine

Predictors of positive sputum cultures in exacerbations of chronic obstructive pulmonary disease

Background and objective: Although sputum culture in patients with an acute exacerbation of COPD is of uncertain value, it is routinely done. The ability to clinically identify patients likely or unlikely to yield bacterial sputum isolates would potentially reduce unnecessary tests. The objective of this study was to identify the clinical predictors of positive sputum cultures in this patient population. Methods: Consecutive patients with a COPD exacerbation requiring an emergency visit were prospectively enrolled. Quantitative sputum culture was performed on-site. Data on current smoking, sputum purulence, FEV 1, Medical Research Council chronic dyspnoea scale, BMI, severe exacerbations in the preceding year requiring hospitalization, PaO 2, PaCO 2, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and oral and inhaled steroid use were recorded. Results: Of the 94 patients enrolled, sputum from 36 yielded bacterial pathogens. These patients were characterized by a higher frequency of purulent sputum, lower FEV 1, BMI and PaO 2, higher APACHE II score and more frequent use of inhaled steroids (P &amp;lt; 0.05). On multivariate regression, purulent sputum, FEV 1 and BMI were independent determinants of a positive sputum culture. Using receiver-operator-optimized thresholds for these variables (purulent sputum, FEV 1 &amp;lt; 35% predicted and BMI ≤ 22 kg/m 2), we proposed a regression coefficient-weighted prediction model that accurately determined the likelihood of sputum bacterial isolation. Conclusions: A prediction model based on the variables of purulent sputum, FEV 1 and BMI predicted sputum culture result with about 90% accuracy. Pending further validation, this model may save valuable healthcare resources. © 2009 Asian Pacific Society of Respirology