Document Detail

Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence-based guidelines.
MedLine Citation:
PMID:  19811556     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV).
AIMS: The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care.
METHODS: A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV.
RESULTS: Of 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia).
CONCLUSIONS: There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.
J Considine; M Botti; S Thomas
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Internal medicine journal     Volume:  41     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-26     Completed Date:  2011-06-07     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  48-54     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.
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MeSH Terms
Adrenal Cortex Hormones / therapeutic use
Adrenergic beta-Agonists / therapeutic use
Bronchodilator Agents / therapeutic use
Cholinergic Antagonists / therapeutic use
Combined Modality Therapy
Emergency Service, Hospital / standards,  statistics & numerical data*
Evidence-Based Medicine
Guideline Adherence
Hospital Records
Hospitals, Private / statistics & numerical data
Hospitals, Public / statistics & numerical data
Hospitals, Urban / statistics & numerical data
Intermittent Positive-Pressure Ventilation
Medical Audit
Middle Aged
Practice Guidelines as Topic
Pulmonary Disease, Chronic Obstructive / drug therapy,  therapy*
Retrospective Studies
Sampling Studies
Young Adult
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Adrenergic beta-Agonists; 0/Bronchodilator Agents; 0/Cholinergic Antagonists
Comment In:
Intern Med J. 2010 Aug;40(8):604-5; author reply 606-7   [PMID:  20718890 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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