Assessment of the Appropriateness Admission From Emergency Departments in the Exacerbation of COPD. Validity of Explicit Criteria and Study of the Variability Between Different Centers of NHS. Multicenter Study IRYSS-Appropriateness-COPD.

A prospective cohort study was performed to validate the explicit criteria developed by the RAM. Other goals for the cohort study were: to predict mortality, ICU or IRCU admission, hospital length of stay, changes in symptoms and to evaluate variability among hospitals in the appropriateness of hospital admission of patients experiencing COPD exacerbations and to study variability in access to care and outcomes. Sixteen hospitals belonging to the Spanish National Health Service agreed to participate: Hospital Costa del Sol, Hospital Valme, Hospital de Motril, Corporació Sanitaria Parc Taulí, Hospital del Mar, Hospital Universitario de La Princesa, Hospital Universitario Gregorio Marañón, Hospital Universitario La Paz, Hospital de Móstoles, Hospital Marqués de Valdecilla, Hospital Santa Marina, Hospital San Eloy, Hospital Galdakao-Usansolo, Hospital Txagorritxu, Complejo Hospitalario Donostia, and Hospital Cruces.

Patients attending the EDs of any of the 16 hospitals with an exacerbation of COPD were informed of the goals of the study and invited to voluntarily participate in it. All information was kept confidential. The Institutional Review Boards of the participating hospitals approved this project. Recruitment started in June 2008 and ended in September 2010.

Patients were candidates for the study if they presented to the ED of any of the participating hospitals with symptoms consistent of an exacerbation of COPD. Exacerbation was defined as an event in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough, and/or sputum that was beyond normal day-to-day variations, was acute in onset, and may have warranted a change in regular medication in a patient with underlying COPD. Two possible presentations were considered:

Existing COPD. Patients were considered to have been previously diagnosed with COPD if they had a FEV1/forced vital capacity (FVC) quotient <70%, and a negative bronchodilation test with FEV1 change <200 mL and under 15% of the baseline value.

New COPD. Patients not previously diagnosed with COPD but in whom the disease was suspected were also eligible for inclusion in the study. This included smokers or former smokers of more than 15 packs per year with dyspnea, cough, or expectoration for more than three months per year, and experiencing symptoms resembling a clinical manifestation compatible with COPD exacerbation. The diagnosis had to be confirmed by spirometry within 60 days after the index episode at a time when the patient was stable, i.e., the absence of any increase in symptoms or changes in background therapy. If a diagnosis of COPD was not confirmed, the patient was excluded from the study.