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Exacerbations of chronic obstructive pulmonary disease (ECOPD) remain a common cause of hospital admission in the UK, despite the huge amount of effort and resources that have been invested in COPD services in recent years, and in-hospital mortality has been unchanged at around 4%.1 Clinical teams looking after patients with ECOPD need well-validated tools to assess mortality risk at admission and detect clinical deterioration in a timely manner. Several such tools have been developed to predict in-hospital mortality, of which the Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score has received the greatest attention2 3 indeed, the 2014 UK National COPD Audit report recommended the DECAF score for all patients hospitalised for ECOPD, in part to enable adjustment for mortality risk in a mixed cohort. Yet despite being robustly derived and validated, the DECAF score has not been widely adopted into clinical practice; in the 2019 National COPD Audit report, DECAF was recorded in only 17.5% of admissions1 and it is therefore worthwhile to consider alternatives.
Introduced in 2012, the National Early Warning Score (NEWS) was designed to standardise the clinical response to the deteriorating patient. Derived from routinely measured physiological parameters, it was validated as an indicator of clinical deterioration and mortality in several acute medical conditions. Despite its widespread use, questions were raised over its safety in the management of patients at risk of hypercapnic respiratory failure, for whom the addition of supplemental oxygen might lower their NEWS, but inadvertently place them at risk of worsening hyperoxic hypercapnia.4 Furthermore, patients with chronic hypoxaemia and on long-term oxygen therapy may have inappropriately elevated scores by virtue of their being on supplementary oxygen even when their acute illness has stabilised, resulting in inappropriate escalation for medical review. In response, the Royal College of Physicians introduced …
Contributors E-SS and BS wrote the manuscript and contributed equally to the critical revision and the final approval.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests E-SS reports receiving an unrestricted educational grant from Philips Research to develop a physiological biomarker in COPD. BS reports no competing interests.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.
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