Niewoehner et al developed a score for predicting hospitalization in a patient with chronic obstructive pulmonary disease (COPD). This can help identify a patient who may require more aggressive management. The authors are from multiple Veterans Affairs hospitals across the United States.
Parameters:
(1) age in years
(2) observed FEV1 as percent of predicted FEV1
(3) oral steroid therapy at entry
(4) cardiovascular comorbidity
(5) number of unscheduled outpatient visits (clinic or ED) for COPD in prior year
(6) number of hospital admissions for COPD in prior year
|
Parameter |
Finding |
Points |
|---|---|---|
|
age in years |
< 70 years of age |
0 |
|
|
70 to 74 years |
12 |
|
|
75 to 79 years |
23 |
|
|
80 to 84 years |
35 |
|
|
>= 85 years |
46 |
|
FEV1 as percent of predicted |
10 to 19% |
89 |
|
|
20 to 29% |
78 |
|
|
30 to 39% |
67 |
|
|
40 to 49% |
56 |
|
|
50 to 59% |
44 |
|
|
60 to 69% |
33 |
|
|
>= 70% |
0 |
|
oral steroid therapy at entry |
absent |
0 |
|
|
present |
22 |
|
cardiovascular comorbidity |
none |
0 |
|
|
one or more |
28 |
|
unscheduled outpatient visits |
0 |
0 |
|
|
1 |
3 |
|
|
>= 2 |
24 |
|
number of hospital admissions for COPD |
0 |
0 |
|
|
1 or more |
40 |
where:
• An FEV1 < 10% of predicted is probably incompatible with life. An FEV1 >= 70% of predicted can be handled in several ways. For the implementation I set it to 0.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 249
• The higher the score the greater the risk of being hospitalized for the COPD.
|
Total Score |
Percent of Patients Hospitalized Within The Next 6 Months |
|---|---|
|
< 75 |
< 3% |
|
75 to 225 |
(0.00375 * ((points)^2)) - (0.6443 * (points)) + 31.03 |
|
> 225 |
> 77% |
Purpose: To determine if a patient with moderate to severe COPD is at risk for being hospitalized using the score of Niewoehner et al.
Specialty: Pulmonology
Objective: severity, prognosis, stage, disease progression
ICD-10: J40, J41, J42, J43, J44, J47,
