Appropriateness of diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation

Rationale, aims and objectives To assess the adequacy of diagnostic effort in the emergency departments of S panish 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 A ndalusia, C atalonia, M adrid and the B asque C ountry. 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 S panish public hospitals. In a high percentage of cases (40%), proper assessment was not conducted. Moreover, inter‐individual and inter‐hospital differences were observed.