Introduction Each year chronic obstructive pulmonary disease (COPD) causes approximately 23,000 deaths in England. Patients are admitted daily with exacerbation of COPD which can often be life-threatening. Steer et al have shown the use of DECAF score to predict inpatient mortality in COPD exacerbation. The DECAF score stratifies patients into low, intermediate and high risk dependant on their admission score.
Aim The aim of our study was to further evaluate the accuracy of DECAF score as a prognostic tool for patients admitted with exacerbation of COPD.
Method A retrospective review of notes of patients admitted with COPD exacerbations between December 2012 and January 2013 was undertaken. The data collected was used to determine the DECAF score which was compared to inpatient mortality, 30 days post-discharge mortality, usage of NIV and readmission within 3 months.
Results 159 patient notes were reviewed. 62.3% were classified as low risk according to DECAF score, with a 4.0% inpatient mortality. 22% were intermediate risk with 2.6% inpatient deaths. 15.7% of the patients were high risk, out of which 40% died as an inpatient. In addition, high DECAF score showed increased risk of 30 days post discharge mortality with 33.3% deaths in high risk patients (Table 1). The DECAF score did not predict the use of NIV. There was however a trend towards increasing use of NIV with higher DECAF score. 90 day readmission data showed similar patterns between risk groups based on DECAF score.
Conclusion Our study showed that high DECAF score is a strong predictor of inpatient and 30 day mortality in patients admitted with COPD exacerbation. A high DECAF score did not predict the need for NIV and it did not appear useful in predicting readmission over a 3 months period. The use of DECAF score in clinical settings would help guide physicians to risk stratify patients, to plan management and to determine whether patients are cared for in high dependency unit, respiratory or a general ward. It may be useful in guiding levels of support for patients by community teams on discharge to prevent adverse events.