Stiell et al developed a risk scale for identifying a patent with COPD in the Emergency Department who is at risk for a serious adverse event. This can help to identify a patient who should be admitted to the hospital or have more aggressive management. The authors are from the University of Ottawa, Ottawa Hospital Research Institute, University of Alberta, Queen's University, University of Calgary and University of Toronto.
Patient selection: COPD in Emergency Department
Outcome: death, intubation, subsequent return to ED with admission, admission to monitored unit
Key parameters for predicting adverse outcome:
(1) history of prior intubation for respiratory distress
(2) initial heart rate on ED arrival in beats per minute
(3) ability to perform the walk test after initial treatment in ED
(4) hemoglobin in g/L
(5) blood urea in mmol/L
Additional parameters:
(6) history of coronary bypass graft
(7) history of peripheral vascular disease intervention
(8) ischemic changes on ECG
(9) pulmonary congestion seen on chest X-ray
(10) serum CO2 in mmol/L (CO2 content)
|
Parameter |
Finding |
Points |
|
history of prior intubation |
no |
0 |
|
|
yes |
2 |
|
initial heart rate |
< 110 beats per minute |
0 |
|
|
>= 110 beats per minute |
2 |
|
able to perform walk test |
yes |
0 |
|
|
no |
2 |
|
hemoglobin |
>= 100 g/L |
0 |
|
|
< 100 g/L |
3 |
|
blood urea |
< 12 mmol/L |
0 |
|
|
>= 12 mmol/L |
1 |
|
history of coronary bypass graft |
no |
0 |
|
|
yes |
1 |
|
history of peripheral vascular disease intervention |
no |
0 |
|
|
yes |
1 |
|
ischemic changes on ECG |
no |
0 |
|
|
yes |
2 |
|
pulmonary congestion on chest X-ray |
no |
0 |
|
|
yes |
1 |
|
serum CO2 |
< 35 mmol/L |
0 |
|
|
>= 35 mmol/L |
1 |
where:
• Patients who were too ill to do the walk test had an SaO2 < 90% or heart rate >= 120 beats per minute.
• The cutoff for hemoglobin was not gender-specific.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the greater the risk of a serious adverse event.
|
Score |
Percent Risk |
Risk Group |
|
0 |
2% |
low |
|
1 |
4% |
intermediate |
|
2 |
7% |
intermediate |
|
3 |
13% |
high |
|
4 |
21% |
high |
|
5 |
33% |
very high |
|
6 |
48% |
very high |
|
7 |
63% |
very high |
|
8 |
76% |
very high |
|
9 |
76-91% (none in study) |
very high |
|
10 |
91% |
very high |
|
11 to 16 |
> 91% (none in study) |
very high |
Purpose: To evaluate a patient presenting to the Emergency Room (ER) with COPD using the Ottawa COPD risk scale.
Specialty: Pulmonology
Objective: risk factors, clinical diagnosis, including family history for genetics, criteria for diagnosis
ICD-10: J44,
