Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department

Abstract

BACKGROUND: The Ottawa chronic recorded on a data form along with the would increase sensitivity for short-term obstructive pulmonary disease (COPD) total risk score. We followed patients for serious outcomes from 51.9% to 79.3% Risk Scale (OCRS), which consists of 30 days and the primary outcome, short- and increase admissions from 45.0% to 10 criteria, was previously derived to term serious outcomes, was defined as 56.6%. A threshold of greater than 2 identify patients in the emergency any of death, admission to monitored would improve sensitivity to 71.9% with department with COPD who were at high unit, intubation, noninvasive ventilation, 47.9% of patients being admitted. risk for short-term serious outcomes. We myocardial infarction (MI) or relapse with sought to validate, prospectively and hospital admission. INTERPRETATION: In this clinical valida-explicitly, the OCRS when applied by tion of a risk-stratification tool for COPD physicians in the emergency department. RESULTS: We enrolled 1415 patients in the emergency department, we found with a mean age of 70.6 (SD 10.6) years that OCRS showed better sensitivity for METHODS: We conducted this prospec- and 50.2% were female. Short-term seri-short-term serious outcomes compared tive cohort study involving patients in the ous outcomes occurred in 135 (9.5%) with current practice. This risk scale can emergency departments at 6 tertiary care cases. Incidence of short-term serious now be used to help emergency depart-hospitals and enrolled adults with acute outcomes ranged from 4.6% for a total ment disposition decisions for patients exacerbation of COPD from May 2011 to score of 0 to 100% for a score of 10. with COPD, which should lead to a December 2013. Physicians evaluated Compared with current practice, an decrease in unnecessary admissions patients for the OCRS criteria, which were OCRS score threshold of greater than 1 and in unsafe discharges.