A two-minute bedside assessment is associated with ED disposition and 30-day mortality in COPD exacerbations: The Barthel Index
Abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of emergency department (ED) attendance, yet admission decisions lack validated bedside tools.
Objectives: To identify predictors of admission and 30-day mortality in ED AECOPD, test whether they differ by ARF status, and derive parsimonious bedside models.
Methods: Secondary analysis of a prospective, multicentre registry (PREURG-CyL) spanning 14 EDs in Spain (01 November 2022 to 31 May 2023). Adults with AECOPD were followed for 30 days. Primary outcomes were hospital admission and 30-day all-cause mortality. Multivariable logistic regression with pre-specified stratification by acute respiratory failure (ARF) status. Internal validation used bootstrap resampling (1000 replications).
Results: Of 1214 analyzed patients (mean age 74.3 years; 72.1% male), 693 (57.1%) were admitted and 64 (5.3%) died within 30 days. ARF dominated admission overall (OR 16.12). Stratified analysis revealed that among patients with ARF (87.7% admitted), functional independence (Barthel = 100) was the sole factor associated with lower admission (OR 0.50, 95% CI 0.27-0.93); among those without ARF (30.8% admitted), male sex and age were the key predictors. The Barthel Index was the strongest predictor of 30-day mortality cohort-wide (OR 0.28, 95% CI 0.15-0.53; 72% risk reduction). Bootstrap-corrected AUC was 0.806 for admission and 0.787 for mortality.
Conclusion: The Barthel Index - a two-minute…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,214 participants or records.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.