Quintana et al developed a score for predicting mortality for COPD patient who is having an exacerbation. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in Spain and members of the IRYSS-COPD Group.
Patient selection: ED patient with an exacerbation of COPD
Parameters:
(1) age in years
(2) baseline dyspnea using the MRC dyspnea scale
(3) previous use of long-term home oxygen therapy (LTHOT) or non-invasive mechanical ventilation (NIMV) at home
(4) altered level of consciousness (Glasgow coma score)
(5) use of inspiratory accessory muscles or paradoxical breathing upon ED arrival
|
Parameter |
Finding |
Points |
|
age in years |
<= 85 years |
0 |
|
|
> 85 years |
3 |
|
baseline dyspnea |
MRC 1 to 4 |
0 |
|
|
MRC 5 (at rest or with minimal effort) |
5 |
|
use of LTHOT or NIMV |
no |
0 |
|
|
yes |
3 |
|
altered level of consciousness |
no |
0 |
|
|
yes |
3 |
|
inspiratory muscles or paradoxical breathing |
no |
0 |
|
|
yes |
4 |
where:
• An altered level of consciousness was an Glasgow coma score <= 14.
• Paradoxical breathing is inward motion of the chest wall during inhalation rather than outward.
• Baseline dyspnea is presumed to be the level of dyspnea prior to the exacerbation.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the more severe the COPD exacerbation.
|
Score |
Risk Group |
30-Day Mortality |
|
0 (no 1 or 2) |
mild |
0.5% |
|
3 to 6 |
moderate |
2.5% |
|
7 to 11 |
severe |
6% |
|
12 to 18 |
very severe |
28% |
Performance:
• The area under the ROC curve was 0.85.
Specialty: Pulmonology
