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 admitted to medical ward (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 during first 24 hours (from 0 to 6)
(4) cardiovascular disease
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
|
< 60 years
|
0
|
|
|
60 to 80 years
|
1
|
|
|
> 80 years
|
2
|
|
MRC dyspnea
|
0 or 2
|
0
|
|
|
3 to 5
|
3
|
|
number of clinical signs
|
0
|
0
|
|
|
1 or 2
|
1
|
|
|
3 to 6
|
2
|
|
cardiovascular disease
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score 9
• The higher the score the greater the in-hospital mortality.
|
Total Score
|
Mortality
|
|
0
|
0%
|
|
1 or 2
|
1.6%
|
|
3 to 9
|
5.5%
|
Performance:
• The area under the ROC curve was 0.79.
• The sensitivity was 0.77 and specificity 0.67
