Establishing Criteria for Pulmonary Exacerbation Based on Severity Score in Adult Cystic Fibrosis Patients

Abstract

PURPOSE: In Cystic Fibrosis (CF) patients Acute Pulmonary exacerbation (PEx) is considered as an important indicator of outcomes in clinical trials, quality of care and progression of disease.Yet there exists no standard definition of PEx. We are conducting an ongoing QI project to establish criteria for PEx based on pulmonary exacerbation score (PES) for use in clinical decision making and standardization of care to improve clinical outcomes in patient care at our CF clinic. METHOD(S): Subjects are adult CF patients seen at Saint Louis University hospital CF clinic from November 2012. Using the literature on PEx, we have adopted the 14 element scoring system used at Akron Children's Hospital that consists of systemic signs and symptoms ,pulmonary signs and symptoms and objective measurements (fev1,cxr and spo2) and is administered at every CF clinic visit. A threshold PES for the presence of PEx was based on available medical literature and adopted from Akron Children's Hospital . PES of >=5 was defined as presence of PEx and treatment with either oral or IV antibiotics were recommended. RESULT(S): This is an ongoing study . Until 08/08/13, we have 85 clinic visits. PES was calculated during all visits representing 100% utilization rate. Of these 23 patients had PES>=5 representing 27.1 % and thus met the criteria for PEx. Of these 23 patients, 17 were treated with antibiotics representing 73.9 % adherence to advice to treat with antibiotics for PES>=5. Of these 17, 9(52.9%%) received oral antibiotics and 8(47.1%%) received IV antibiotics. One pt refused IV antibiotics secondary to financial constraints. Outcomes of interests are change in FEV1, antibiotic use, hospitalization rates, before and after the implementation of the PES program. We intend to incorporate the PES into our clinic visit record and make it a standard of care. CONCLUSION(S): This is an ongoing study. We intend to show that establishing criteria for Acute PEx based on severity scoring will result in common and standardized approach among our CF clinicians resulting in Improved FEV1, reduced hospitalizations, timely use of antibiotics and enable us to compare effect of various interventions on outcomes.