Maryam Razavi

maryam.razavi@cambio.se

@CambioCDS

To Risk-stratify patients with acute COPD exacerbation can allow for safer disposition decisions (i.e., avoid admitting patients suitable for discharge, and avoid discharging patients at risk for adverse event).

Use in patients presenting to the ED with acute COPD exacerbation. Ottawa risk scale score formula: Addition of the selected points: Variables and Points: - History: Coronary bypass graft=1, Intervention for peripheral vascular disease=1, Intubation for respiratory distress (any history)=2. - Examination: HR ≥110/min (on arrival to ED)=2, Too ill to do walk test* after treatment in ED (SaO2 <90% or HR ≥120/min)=2 (SaO2 <90% or HR ≥120/min after 3 minute walk test ( 3 min walk test can be performed with the patient walking at their own pace regardless of distance and their normal walking aids (but they could not be supported by another person)). - Investigations: Acute ischemic changes on EKG (by clinician judgment)=2, Pulmonary congestion on chest x-ray (by clinician judgment)=1, Hemoglobin <10 g/dL (100 g/L)=3, Urea ≥12 mmol/L (BUN ≥34 mg/dL)=1, Serum CO2 ≥35 mEq/L (35 mmol/L)=1. Interpretation: COPD Risk Scale, Risk group, Risk of adverse event*: 0= Low Risk Group= 2.2% 1=Medium Risk Group= 4% 2=Medium Risk Group=7.2% 3=High Risk Group=12.5% 4=High Risk Group=20.9% >=5=Very High Risk Group 5= 32.9% Risk of adverse event 6= 47.5% Risk of adverse event 7= 62.6% Risk of adverse event 8= 75.6% Risk of adverse event 10= 91.4% Risk of adverse event 9 or >10= No information. * Defined as all-cause 30-day mortality or any of the following within 14 days of the index ED visit (regardless of whether patient was initially admitted): - Admission to a monitored unit (excluding monitoring by telemetry). - Intubation/need for noninvasive ventilation after hospital admission (unless already on home oxygen). - MI, as defined by international consensus standards (Alpert 2000). - Major procedure (CABG, PCI, other cardiac surgery, or new hemodialysis). - Return to the ED for any related medical problem within 14 days, followed by hospital admission (if discharged after initial visit).

Not to be used in patients who are obviously too ill for discharge (e.g. hypotensive, severe dementia, ischemic chest pain, etc).

1. Stiell IG, Clement CM, Aaron SD, et al. Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study. CMAJ. 2014;186(6):E193-204. 2. Stiell IG, Perry JJ, Clement CM, et al. Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department. CMAJ. 2018;190(48):E1406-E1413. 3. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36(3):959-69. 4. Pan AM, Stiell IG, Clement CM, et al. Feasibility of a structured 3-minute walk test as a clinical decision tool for patients presenting to the emergency department with acute dyspnoea. Emergency Medicine Journal. 2009;26:278-282.

OBSERVATION.ottawa_copd_risk_scale.v0, EVALUATION.ottawa_copd_risk_scale.v0