Tool identifies patients with COPD at risk for serious complications

The Ottawa COPD Risk Scale — which assessed a combination of 10 factors — ascertained which patients with COPD were more likely to have short-term serious outcomes better than current practice, according to findings recently published in the Canadian Medical Association Journal.

“Unfortunately, there is little evidence to inform disposition decisions [for COPD exacerbations] by physicians. Existing guidelines for disposition decisions are consensus-based and have not been validated. Several authors have developed risk-stratification scores for COPD exacerbations; however, most are limited by predicting death only among admitted patients or have not been validated clinically in real time in the emergency department,” Ian G. Stiell, MD, MSc, of the departments of medicine and emergency medicine at the Ottawa Hospital Research Institute in Canada and colleagues wrote.

“There have been no robust evaluations of risk factors to assist with the admission decision for patients with COPD in the emergency department. Prospective studies conducted in the emergency department are limited by small sample size, no reassessment of response to therapy and no prospective validation,” they continued.

Stiell and colleagues had previously developed the Ottawa COPD Risk Scale, a 10-item questionnaire that allocates one to three points based on the following: histories of coronary artery bypass graft, peripheral vascular disease intervention and respiratory distress intubation, X-ray results with pulmonary congestion; ECG with acute ischemic changes; heart rate on ED arrival; hemoglobin less than 100 g/L; urea of 12 mmol/L; and serum CO₂ of 33 mmol/L.

Researchers compared the scale’s scores vs. current practice in 1,415 patients (mean age, 70.6 years, 50.2% women) They found that short-term serious outcomes occurred in 135 cases. Compared with current practice, a risk score threshold of greater than 2 improved sensitivity to 71.9%, with 47.9% of patients being admitted, while a threshold of greater than 1 increased sensitivity for short-term serious outcomes from 51.9% to 79.3% and increased admissions from 45% to 56.6%.

“We intend that [the Ottawa COPD Risk Scale] be used in a pragmatic fashion to ensure that patients are managed in a safe and efficient manner, and we do not advocate for a specific risk score total that would require admission,” Stiell and colleagues wrote.

“We see the Ottawa COPD Risk Scale as an important tool to help physicians gauge the medical risk for their patients with COPD, while they determine the need for admission or early follow-up,” they added. – by Janel Miller

Disclosures : Healio Family Medicine was unable to determine the authors’ relevant disclosures prior to publication.