Evidence map›Paper›PMID 37580731›Full record

Trial reportBMC pulmonary medicine2023

Complexity in clinical diagnoses of acute exacerbation of chronic obstructive pulmonary disease.

Alexandre J Pratt, Andrew Purssell, Tinghua Zhang, Vanessa P J Luks, Xavier Bauza, Sunita Mulpuru, Miranda Kirby, Shawn D Aaron, Juthaporn Cowan

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC pulmonary medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
2.1field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
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  3. Observational
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  5. Article
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  7. Observational
  8. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Alexandre J PrattDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.
Andrew PurssellDivision of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Tinghua ZhangClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Vanessa P J LuksClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Xavier BauzaDepartment of Physics, Toronto Metropolitan University, Ottawa, ON, Canada.
Sunita MulpuruClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Miranda KirbyDepartment of Physics, Toronto Metropolitan University, Ottawa, ON, Canada.
Shawn D AaronClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Juthaporn CowanDivision of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. jcowan@toh.ca.
Ottawa Hospital · CAUniversity of Ottawa · CAToronto Metropolitan University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently.

methodsTo identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea.

resultsThree hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68-6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 - 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 - 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 - 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 - 0.25) suggested against the diagnosis of AECOPD alone.

conclusionThe study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.

Indexed as

Pulmonary Disease, Chronic ObstructiveAcute DiseaseAgedCoughDisease ProgressionDyspneaHumansProspective StudiesRetrospective StudiesAcute exacerbationChronic obstructive pulmonary diseaseDiagnosis

Identifiers

PMID37580731
PMCPMC10426055
OpenAlexW4385810600

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.