COPD exacerbation: physicians were poor at assessing FEV1

Clinical bottom line (level 4)

  1. Physicians were poor at predicting FEV1 in patients with COPD exacerbations and were poor at assessing the response following treatment
Emerman et al: Chest 1994; 105 : 1709-1712
Expires June 2004

The study

Setting: emergency department, university hospital, USA

90 patients (aged mean 63, 51% male) with an acute exacerbation of COPD

Excluded if
  • diagnosed with acute ashtma, congestive heart failure, pneumonia or pneumothorax, lung cancer
  • aged < 50


Independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • spirometry
Diagnostic test: physician estimate of FEV1

The evidence

  • 38% of physicians' estimates were within 10% of actual pretreatment FEV1
  • 46% of physicians' predictions were within 10% of posttreatment FEV1.
  • 49% of patients whom the physician believed had improved (increase in FEV1 by 20%) did not. 31% whom physicians believed had not improved actually did so.
  • Attending physicians were more accurate than residents (p < 0.001).

Citation

  1. Emerman CL, Lukens TW, Effron D: physician estimation of FEV1 in acute exacerbation of COPD. Chest 1994; 105 : 1709-1712
Search Terms: from reference list of AHRQ review
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient COPD exacerbation
Intervention or Exposure physician's prediction of FEV1
Comparison spirometry
Outcome FEV1