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Clinical audit on diagnostic accuracy and management of respiratory failure in COPD.

Abstract

BACKGROUND
The aim of the study was to evaluate the adequacy of diagnosis and management of respiratory failure (RF) in COPD.
METHODS
Retrospective analysis of the hospital discharge forms of COPD patients hospitalized for RF from January 2007 to June 2008. Using the clinical audit tool, the primary end point was the accuracy of RF diagnosis. The secondary end points were mortality, re-hospitalization rate, length of hospital stay, accuracy of long-term oxygen therapy (LTOT) prescription, and agreement of the treatments with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2008 guidelines. Statistical analysis used Pearson and Spearman correlation test and the Cohen kappa for degree of agreement. Differences in demographics and clinical parameters were analyzed with the chi-square test, t test, or the Fisher test, as appropriate.
RESULTS
We studied 130 patients, 81 males (62%), mean ± SD age 76.6 ± 9.1 years. Arterial blood gas analysis (ABG) was performed in 118 patients (90.8%), and in 77 (81%) a P(aO(2)) < 60 mm Hg was found at admission. Of these, 42 cases (54.5%) had no diagnosis of RF, despite a P(aO(2)) < 60 mm Hg. In 18 (19%) P(aO(2)) was ≥ 60 mm Hg; of these, 6 cases (33.3%) received an incorrect RF diagnosis. At discharge 8.1% of patients did not receive a diagnosis of RF, despite a compatible ABG. The highest mortality was found in the medicine departments (14.7%). The re-hospitalization rate at 90 days was 19.5%. Adherence of the treatment to the GOLD guidelines during hospitalization was confirmed in 75.8% of patients. In 41.1% of cases LTOT was prescribed at discharge; in 24 out of 27 cases P(aO(2)) values were < 55 mm Hg.
CONCLUSIONS
Agreement between diagnosis of RF and ABG values was found to be insufficient in about half the cases. Among secondary end points, adherence of the treatment to guidelines and LTOT prescription were, however, found to be good. Data showed significant inaccuracies in the management of RF at our institution.

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  • Authors

    Menzella F, Facciolongo N, Lusuardi M, Piro R, Formisano D, Castagnetti C, Simonazzi A, Zucchi L

    Institution

    Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.

    Source

    Respiratory care 57:12 2012 Dec pg 2067-73

    MeSH

    Aged
    Aged, 80 and over
    Comorbidity
    Female
    Humans
    Length of Stay
    Male
    Medical Audit
    Oxygen Inhalation Therapy
    Pulmonary Disease, Chronic Obstructive
    Respiratory Insufficiency
    Retrospective Studies

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22613356