TY - JOUR T1 - Comparison of Two Scores for Short Term Outcomes in Patients with COPD Exacerbation in ED: The Ottawa COPD Risk Scale and the DECAF Score JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00436-2022 SP - 00436-2022 AU - Ali Unal AU - Basak Bayram AU - Begum Ergan AU - Kazim Can AU - Yagiz Kagan Ergun AU - Oguz Kilinc Y1 - 2022/01/01 UR - http://openres.ersjournals.com/content/early/2022/11/10/23120541.00436-2022.abstract N2 - Background While clinical decision rules have been developed for the evaluation of exacerbations and decisions on hospitalization and discharge in emergency departments (EDs), these rules are not widely used in Eds. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease (COPD) Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) Score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD (ECOPD).Methods This single-center prospective observational study was conducted over six months. Patients with AECOPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalization within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalization for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated.Results Of the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. Sixty-six percent of the patients were male, and the mean age was 70.15±10.36 years. It was observed that 20.7% (n=62) of all patients experienced poor outcomes. The sensitivity of OCRS <1 for predicting a poor outcome in patients was 96.8% (95% CI: 88.8–99.6), and the specificity was 18.5% (95% CI: 13.8–24.0). The sensitivity and specificity of OCRS <2 was – 83.3% (95% CI: 35.9–99.6) and 65.5% (95% CI: 59.6–70.7), respectively. The sensitivity and specificity of the DECAF score <1 was – 88.7% (95% CI: 78.1–95.3) and 34.5% (95% CI: 28.4–40.9), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI: 56.4–80.4) and 74.8% (95% CI: 68.8–80.2).Conclusion We observed that our physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may inform unnecessary hospitalization, they can reduce the incidence of hospital discharge of patients with ECOPD who will develop poor outcomes in the ED.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflicts of Interest: The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. ER -