Ottawa Risk Scale in Predicting the Outcome of Chorionic Obstructive Pulmonary Disease Exacerbation in Emergency Department; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 November 2022
,
Page e32
https://doi.org/10.22037/aaem.v11i1.2023
Abstract
Introduction: The disposition decision is a great challenge for clinicians in managing patients with chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to evaluate the accuracy of Ottawa COPD Risk Scale (OCRS) in predicting the short-term adverse events in the mentioned patients.
Methods: This prospective diagnostic accuracy study was conducted on COPD exacerbation cases who were referred to the emergency department (ED). Patients were followed up for 30 consecutive days for adverse events including the need for intubation, non-invasive ventilation, myocardial infarction, readmission, and death from any cause, and finally the accuracy of OCRS in predicting the outcome was evaluated.
Results: 362 patients with the mean age of 65.55 ± 10.65 (6- 95) years were evaluated (58.0% male). Among the patients, 164 (45.3%) cases were discharged from ED, and 198 (54.7%) were admitted to the hospital. 136 (37.6%) cases experienced at least one of the studied short-term adverse events. The mean OCSD score of this series was 1.96 ± 2.39 (0 – 10). The area under the curve of OCRS in predicting the outcome of COPD patients was 0.814 (95%CI: 0.766 – 0.862). The best cut-off point of the scale in predicting the outcome was 1.5. The sensitivity and specificity of the scale were 75.75% (95%CI: 69.6% – 81.42%) and 89.63% (95%CI: 83.67% – 93.66%), respectively. By employing this threshold, 48 (13.25%) cases would have unnecessary hospitalization, and 17 (0.04%) would be discharged incorrectly.
Conclusion: The OCRS has acceptable level of prediction accuracy in predicting the short-term adverse event of COPD patients. The use of this scoring in the routine practice of ED clinicians can lead to a reduction in unnecessary admissions and unsafe discharge for these patients.
- Pulmonary Disease, Chronic Obstructive
- Risk Assessment
- Patient Outcome Assessment
- ; Sensitivity and Specificity
- Clinical Decision Rules
How to Cite
References
2. Rabe KF, Watz H. Chronic obstructive pulmonary disease. Lancet (London, England). 2017;389(10082):1931-40.
3. Barnes PJ, Burney PG, Silverman EK, Celli BR, Vestbo J, Wedzicha JA, et al. Chronic obstructive pulmonary disease. Nature reviews Disease primers. 2015;1:15076.
4. Zafar MA, Loftus TM, Palmer JP, Phillips M, Ko J, Ward SR, et al. COPD Care Bundle in Emergency Department Observation Unit Reduces Emergency Department Revisits. Respiratory care. 2020;65(1):1-10.
5. Kim S, Emerman CL, Cydulka RK, Rowe BH, Clark S, Camargo CA. Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation. Chest. 2004;125(2):473-81.
6. Rowe BH, Villa-Roel C, Guttman A, Ross S, Mackey D, Sivilotti ML, et al. Predictors of hospital admission for chronic obstructive pulmonary disease exacerbations in Canadian emergency departments. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2009;16(4):316-24.
7. Stiell IG, Clement CM, Aaron SD, Rowe BH, Perry JJ, Brison RJ, et al. Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2014;186(6):E193-204.
8. Stiell IG, Perry JJ, Clement CM, Brison RJ, Rowe BH, Aaron SD, et al. Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2018;190(48):E1406-e13.
9. Kocak AO, Cakir Z, Akbas I, Gur STA, Kose MZ, Can NO, et al. Comparison of two scores of short term serious outcome in COPD patients. The American journal of emergency medicine. 2020;38(6):1086-91.
10. Unal A, Bayram B, Ergan B, Can K, Ergun YK, Kilinc O. Comparison of two scores for short-term outcomes in patients with COPD exacerbation in the emergency department: the Ottawa COPD Risk Scale and the DECAF score. ERJ Open Res. 2023;9(2):00436-2022.
11. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. The New England journal of medicine. 2004;350(10):1005-12.
12. Roche N, Zureik M, Soussan D, Neukirch F, Perrotin D. Predictors of outcomes in COPD exacerbation cases presenting to the emergency department. The European respiratory journal. 2008;32(4):953-61.
13. Steer J, Gibson J, Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax. 2012;67(11):970-6.
14. Hale MK, Stiell IG, Clement CM. Emergency Department Management of Heart Failure and COPD: A National Survey of Attitudes and Practice. Cjem. 2016;18(6):429-36.
- Abstract Viewed: 386 times
- pdf Downloaded: 695 times
