Roche et al evaluate patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) presenting to the Emergency Department (ED). A simple score can help to identify patients who may benefit from more aggressive management. The authors are from Cochin Hospital and University Paris Descartes.
Patient selection: acute exacerbation of COPD presenting to the ED (exclusion direct ICU admission or ventilatory support)
Outcome: in-hospital mortality
Parameters:
(1) age in years
(2) MRC dyspnea grade at steady state (from 0 to 5)
(3) number of signs of severity at presentation (from 0 to 6)
Signs of severity:
(1) cyanosis
(2) use of accessory inspiratory muscles
(3) paradoxical abdominal movement
(4) asterixis
(5) neurological impairment
(6) lower limb edema
Parameter
Finding
Points
age in years
< 70 years
0
>= 70 years
1
MRC dyspnea
0 or 1
0
2 or 3
1
4 or 5
2
number of clinical signs
0
0
1 or 2
2
3 to 6
3
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score 6
• The higher the score the greater the in-hospital mortality.
Total Score
Mortality
0 or 1
0.7%
2 or 3
1.6%
4 to 6
6.3%
Performance:
• The area under the ROC curve was 0.79 in the derivation cohort and 0.83 in the internal validation cohort.
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