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Eur J Intern Med. 2019 Mar;61:62-68. doi: 10.1016/j.ejim.2018.10.018. Epub 2018 Oct 31.

Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU).

Author information

1
Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: federicogermini@gmail.com.
2
Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy.
3
Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada.
4
Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
5
Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
6
Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy.
7
Università della Campania Luigi Vanvitelli, Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, Ospedale Clinicizzato di Marcianise, Marcianise (CE), Italy.
8
Pronto Soccorso e Medicina D'urgenza, Ospedale Civile di Vignola AUSL, Modena, Italy.
9
U.O.C Ps-OBI A.O.R.N A, Cardarelli di Napoli, Italy.
10
Dipartimento di Scienza della Salute, Università degli studi di Milano Bicocca, Italy.
11
Pronto Soccorso Ospedale A. Murri, Fermo, Italy.
12
Pronto Soccorso OCSAE-Azienda Ospedaliero Universitaria Policlinico OCSAE, Modena, Italy.
13
Nuovo Ospedale di Sassuolo, Modena, Italy.
14
Pronto Soccorso, AAS2 Bassa Friulana-Isontina, Ospedale di Monfalcone (Go), Italy.
15
U.O. Medicina d'Urgenza-Pronto Soccorso, Presidio Ospedaliero "Bufalini-Marconi-Angiloni", Cesena, Italy.
16
Geriatria, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy.
17
Emergenza Alta Specializzazione (Pronto soccorso), ASST Papa Giovanni XXIII di Bergamo, Italy.
18
Unità Operativa di Pronto Soccorso ed Emergenza territoriale, Area Nord Bologna, Italy.
19
Pronto Soccorso e Medicina d'Urgenza, Ospedale Madonna delle Grazie, Matera, Italy.
20
Pronto Soccorso ospedale San Martino, Belluno, Italy.
21
Pronto Soccorso, ASST Melegnano e Martesana, Presidio di Vizzolo Predabissi, Milano, Italy.
22
S.C. di Medicina e Chirurgia d'Urgenza e Accettazione, Humanitas "Gradenigo", Torino, Italy.
23
Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, Catania, Italy.
24
Università degli Studi di Modena e Reggio Emilia, Italy.
25
Pronto Soccorso, Ospedale A. Manzoni, Azienda Ospedaliera di Lecco, Lecco, Italy.
26
Pronto Soccorso e Medicina d'Urgenza, Ospedale di Imola (BO), Italy.
27
Dipartimento di Emergenza e Accettazione, Presidio Grosseto, Azienda Usl Toscana sud est, Italy.
28
Responsabile PS, Ospedale di Petralia Sottana (PA), Italy.
29
Medicina d'Accettazione e d'Urgenza P.O. Pescia (PT), Italy.
30
Human Pathology Department, University Hospital "G. Martino" of Messina, Messina, (Italy).
31
Pronto Soccorso, Ospedale S. Paolo, Savona, ASL 2, Liguria, Italy.
32
Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Parma, Parma, Italy.
33
UO Pronto Soccorso e Medicina d'Urgenza, Ospedale "Madonna del Soccorso", San Benedetto del Tronto, Italy.
34
Pronto Soccorso, Ospedali riuniti Padova Sud Madre Teresa di Calcutta, Azienda ULSS 6 Euganea, Schiavonia, Padova, Italy.
35
Pronto Soccorso, ASST di Vimercate, Ospedale di Vimercate (MB), Italy.
36
Pronto Soccorso, Ospedale Bassini, Cinisello Balsamo, ASST-Nord Milano, Italy.
37
Pronto Soccorso e Medicina D'urgenza, Ospedale Civile di Vignola, AUSL, Modena, Italy.
38
Pronto Soccorso, Medicina D'Urgenza e 118-Ospedale Morgagni-Pierantoni di Forlì, Italy.
39
Pronto soccorso e medicina d'urgenza Pordenone, Italy.
40
U.O.C Ps-OBI A.O.R.N A. Cardarelli di Napoli, Italy.
41
Medicina e Chirurgia d'accettazione e d'urgenza Azienda USL Toscana Nordovest, Italy.
42
Medicina e Chirurgia d'Accettazione ed Urgenza (MeCAU)-Pronto Soccorso, Ospedale S. Andrea, Vercelli, Italy.

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPDE) frequently require hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment model (RAM) based on simple variables, that has been proposed for the prediction of these adverse outcomes in patients with COPDE. If showed to be accurate, the BAP-65 RAM might be used to guide the patients management, in terms of destination and treatment. We conducted a retrospective, multicentre, chart-review study, on patients attending the ED for a COPDE during 2014. The aim of the study was the validation of the BAP-65 RAM for the prediction of in-hospital death or use of IMV (composite primary outcome). We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation) age was 76 (11) years, and 38% of patients were female. The composite outcome occurred in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI 0.59-0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was 44% (95% CI 34%-55%), the specificity was 84% (95% CI 82%-85%), the positive predictive value was 9% (95% CI 6%-12%), and the negative predictive value was 98% (95% CI 97%-98%). CONCLUSIONS: In patients attending Italian EDs with a COPDE, we found that the BAP-65 score did not have sufficient accuracy to stratify patients upon their risk of severe in-hospital outcomes.

KEYWORDS:

Chronic obstructive; Emergency service, Hospital; Prognosis; Pulmonary disease; Risk

PMID:
30391167
DOI:
10.1016/j.ejim.2018.10.018
[Indexed for MEDLINE]

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