New Tool Identifies High-Risk Patients with COPD

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A new predictive tool has shown promise in helping physicians identify patients with chronic obstructive pulmonary disease (COPD) who are at high risk of serious complications, including death, according to a new study.

The tool — the 10-point Ottawa COPD risk scale — performs better than current practice, according to the authors of the study, which was published today in the Canadian Medical Association Journal.

The tool correctly predicted that 135 patients (9.5 percent) would have serious complications, although 65 (8.3 percent) of serious outcomes occurred in the 779 participants who were not admitted to the hospital at their initial visit to the emergency room.

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Researchers used the tool to test whether they could accurately predict short-term complications in patients. The study was conducted in six hospitals in the Canadian provinces Ontario and Alberta, with 1,415 patients over 50 years old who showed up to the emergency room with COPD flare-ups, such as shortness of breath or respiratory distress.

The research team created the risk stratification tool, which comprises 10 items from history, physical examination and bedside tests. The total score estimates the risk of short-term serious outcomes within two weeks, ranging from 2.2 percent to 91.4 percent.

Short-term serious outcomes were defined by the researchers as death, admission to monitored unit, intubation, noninvasive ventilation, myocardial infarction or relapse with hospital admission.

“Before this tool, there was no way to know if a patient who came to the emergency department with a COPD flare-up was going to have dangerous complications,” said Ian Stiell, M.D., senior scientist at The Ottawa Hospital and professor of emergency medicine at the University of Ottawa.

The information can ultimately help doctors decide whether patients need to be admitted.

A major cause of death in North America and Europe, COPD is mainly induced by smoking and affects breathing that worsens over time. The rates of hospital admissions and visits to the emergency room for the disease have been rising over the past decade.

“We intend that [the tool] be used in a pragmatic fashion to ensure that patients are managed in a safe and efficient manner, and we do not advocate for a specific risk score total that would require admission,” the authors wrote.

The predictive tool can be used by respirologists, general internists, family doctors and emergency physicians to help emergency department disposition decisions for patients with COPD, which could decrease unnecessary admissions and unsafe discharges.

“Use of the scale could improve upon the sensitivity of current practice, in which only 51.9 (70/135) percent of short-term serious outcome cases were admitted at the first visit to the emergency department,” the study said.

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