A Consensus-Driven Algorithm for AECOPD Management in Croatian Emergency Departments: Preliminary Initiative
6 affiliations
- 1Clinic for Respiratory Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- 2School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- 3Medical Affairs, AstraZeneca Croatia, 10000 Zagreb, Croatia
- 4Clinic for Respiratory Diseases, University Hospital Centre Split, 21000 Split, Croatia
- 5School of Medicine, University of Split, 21000 Split, Croatia
- 6Emergency Department, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Abstract
Background/Objectives: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of emergency room (ER) visits, yet assessment, treatment, and discharge processes may lack standardization. This initiative aimed to identify perceived practice gaps and develop a consensus-based algorithm for AECOPD management in Croatian ERs. Methods: In 2025, 20 ER physicians from University Hospital Centres Zagreb and Split completed a structured questionnaire, addressing challenges in AECOPD recognition, assessment, treatment, and discharge. Findings were considered alongside Croatian and international COPD guidelines during three iterative, structured multidisciplinary workgroup meetings. The algorithm was tailored to local clinical practice and healthcare organization, with a predefined consensus threshold of more than 80% agreement. Results: The main perceived gaps concerned pharmacological treatment optimization and escalation (90%), discharge planning and follow-up (85%), and decisions regarding non-invasive ventilation, treatment escalation, and hospital admission (80%). These findings served as a basis for developing the clinical algorithm covering early recognition, differential diagnosis, severity assessment, severity-based management, maintenance treatment optimization, and discharge and follow-up recommendations. The algorithm was disseminated through printed posters in 35 major Croatian hospitals, professional society websites, and presentations at national congresses. Conclusions: This initiative translated identified practice gaps, evidence-based recommendations, and multidisciplinary expert input into a pragmatic algorithm for AECOPD management in Croatian ERs. It provides a proposed framework to support standardized assessment, treatment, discharge planning, and referral. Given the small, non-random sample, the findings should be interpreted cautiously. Further evaluation is needed to assess implementation, uptake, and potential effects on clinical practice and patient outcomes.
Related
- Impact evaluation of Lean Healthcare in emergency departments: evidence from a large-scale Brazilian initiative using difference-in-differences
- Use of an Electronic Health Record Algorithm to Identify Persons With Human Immunodeficiency Virus Out Of Care in United States Emergency Departments
- Benchmark Self-Triage (BeST): Comparing Self-Triage Systems and Multiple Generations of OpenAI Models Against Preliminary Expert Consensus
- No significant differences between large language model prompting strategies and human experts in summarisation of 'the formal EU-US meniscus rehabilitation consensus: An ESSKA-AOSSM-AASPT Initiative'.
- A risk management intervention in Australian hospital food service departments: an evaluation using the RE-AIM framework.
BibTeX
@article{stajduhar2026consensusdriven,
title = {{A Consensus-Driven Algorithm for AECOPD Management in Croatian Emergency Departments: Preliminary Initiative}},
author = {Anamarija Štajduhar and Andrea Vukic Dugac and Marijana Janković Danolić and Emilija Lozo Vukovac and Ivan Gornik},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218325},
url = {https://www.mdpi.com/2077-0383/15/21/8325},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A Consensus-Driven Algorithm for AECOPD Management in Croatian Emergency Departments: Preliminary Initiative
AU - Anamarija Štajduhar
AU - Andrea Vukic Dugac
AU - Marijana Janković Danolić
AU - Emilija Lozo Vukovac
AU - Ivan Gornik
PY - 2026
DA - 2026/10/26
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218325
UR - https://www.mdpi.com/2077-0383/15/21/8325
AB - Background/Objectives: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of emergency room (ER) visits, yet assessment, treatment, and discharge processes may lack standardization. This initiative aimed to identify perceived practice gaps and develop a consensus-based algorithm for AECOPD management in Croatian ERs. Methods: In 2025, 20 ER physicians from University Hospital Centres Zagreb and Split completed a structured questionnaire, addressing challenges in AECOPD recognition, assessment, treatment, and discharge. Findings were considered alongside Croatian and international COPD guidelines during three iterative, structured multidisciplinary workgroup meetings. The algorithm was tailored to local clinical practice and healthcare organization, with a predefined consensus threshold of more than 80% agreement. Results: The main perceived gaps concerned pharmacological treatment optimization and escalation (90%), discharge planning and follow-up (85%), and decisions regarding non-invasive ventilation, treatment escalation, and hospital admission (80%). These findings served as a basis for developing the clinical algorithm covering early recognition, differential diagnosis, severity assessment, severity-based management, maintenance treatment optimization, and discharge and follow-up recommendations. The algorithm was disseminated through printed posters in 35 major Croatian hospitals, professional society websites, and presentations at national congresses. Conclusions: This initiative translated identified practice gaps, evidence-based recommendations, and multidisciplinary expert input into a pragmatic algorithm for AECOPD management in Croatian ERs. It provides a proposed framework to support standardized assessment, treatment, discharge planning, and referral. Given the small, non-random sample, the findings should be interpreted cautiously. Further evaluation is needed to assess implementation, uptake, and potential effects on clinical practice and patient outcomes.
SN - 2077-0383
ER -