A two-minute bedside assessment is associated with ED disposition and 30-day mortality in COPD exacerbations: The Barthel Index.

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 bedside assessment requiring no laboratory testing serves a dual function: identifying candidates for outpatient management among patients with ARF, and stratifying 30-day mortality risk. A clinical decision algorithm integrating ARF status and the Barthel Index is proposed.