P45 Practical use of the DECAF score: Can we improve outcomes in acute exacerbation of COPD admissions?

Abstract

BackgroundAcute exacerbations of COPD (AECOPD) are the second most common cause of emergency hospital admission in England and are associated with an inpatient mortality rate of 4.3%.1 The Dyspnoea, Eosinopenia, Consolidation, Acidaemia and Atrial Fibrillation (DECAF) Score, is an effective prognostic tool that predict mortality in AECOPD admissions. This scoring system is easy to apply during admission and has performed better than existing prognostic tools.2 We aim to appraise the efficacy of DECAF score in our busy respiratory and medical admissions unit.MethodHospital admissions with AECOPD from Dec 2014 to Mar 2015 are prospectively reviewed and DECAF score applied to each patient. Morbidity and mortality indicators were then correlated with both total DECAF scores and each predictive index.Results78 admissions were reviewed, 60% were male and the mean age was 72.7 years. Average length of stay was 15.3 days and 12 patients died in hospital. Our results were comparable with previous studies3, with inpatient mortality highest in those with DECAF scores of 3–5 (92%) and lowest in those with scores of 0–1 (0%). Higher DECAF scores were also associated with use of non-invasive ventilation (43%).Furthermore, each individual predictive index within the DECAF score was independently related to an increased mortality rate. There was 44% mortality in patients with atrial fibrillation and 30% mortality in patients with dyspnoea score of eMRC 5B. In-hospital mortality rate increased with each DECAF score (Figure 1).Abstract P45 Figure 1 ConclusionsIntroduction of DECAF score as clinical prediction tool for AECOPD admissions in our departments may be beneficial in reducing morbidity and mortality. Those scoring highest should be considered for early escalation, higher level of care and or palliative management. Those with lower scores may be suitable for early supported discharge. Further study of a larger group however is advisable to confirm the significance of these findings.References1 National Chronic Obstructive Pulmonary Disease Audit Programme: Clinical audit of COPD exacerbations admitted to acute units in England and Wales, 20142 J Steer, J Gibson, S Bourke. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012;67:970–976

Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…In a comprehensive analysis of patients with AECOPD, the highest mortality was seen in patients with DECAF scores of 3-5 (92%). The in-hospital mortality rate increased with every point increase in the DECAF score [8]. In another study with an 18% mortality rate in patients with AECOPD, patients who died scored higher on both DECAF and the BAP-65 metric (B: elevated blood urea nitrogen, A: altered mental status, P: pulse >109, 65: age >65 years).…”

Use of DECAF scoring system to facilitate early discharge in acute exacerbation of COPD patients: a quality improvement project at a district general hospital

“…The DECAF score has been further validated in external cohorts by subsequent studies, which have confirmed that DECAF is well-calibrated with excellent discrimination. 4,7,8 In 2018, a non-inferiority randomised controlled trial showed that low-risk (DECAF score 0-1) patients were suitable candidates for HAH treatment, with similar 90-day readmission and mortality rates between HAH and usual care groups. This protocol comprised nebulisation, intravenous antibiotics, steroids, temporary oxygen at home as well as telephone or in-person review by a respiratory clinical nurse specialist, if necessary.…”