Korean J Crit Care Med.  2013 Nov;28(4):255-265. 10.4266/kjccm.2013.28.4.255.

Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

• Son JH
• Lee JY
• Yang YM
• Sung WY
• Seo SW
• Kim JC
• Lee W

• KMID: 1977501
• DOI: http://doi.org/10.4266/kjccm.2013.28.4.255

Abstract

BACKGROUND
Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department.
METHODS
Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital.
RESULTS
The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001).
CONCLUSIONS
The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.

Keyword

chronic obstructive; emergencies; pulmonary disease

MeSH Terms

Asthma
Discrimination (Psychology)
Emergencies*
Hospital Mortality
Humans
Intensive Care Units
Intubation, Intratracheal
Lung Diseases
Lung Diseases, Obstructive
Nitrogen
Physiology
Prognosis
Pulmonary Disease, Chronic Obstructive*
Respiratory Rate
Urea
Nitrogen
Urea