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New Tool Predicts COPD Patient''s at Risk of Serious Complications

New Tool Predicts COPD Patient's at Risk of Serious Complications

Written by Dr. Lakshmi Venkataraman, MD
Article Reviewed by 
The Medindia Medical Review Team on December 3, 2018 at 3:54 PM
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  • New Ottawa chronic obstructive pulmonary disease (COPD) Risk Scale is a 10-point assessment tool that accurately identifies those patients with sudden COPD aggravations who are at risk of serious complications including death
  • The tool will enable emergency room doctors to make better decisions regarding whether a given patient needs hospital admission or can be safely sent home
  • Chronic obstructive pulmonary disease (COPD) is a group of chronic lung conditions caused by smoking marked by shortness of breath that gradually worsens with time

The 10-point Ottawa COPD Risk scale is a useful tool that would help emergency room physicians among others to make improved decisions regarding the care of COPD patients with flare-ups of their condition. This validation study was conducted in Canada and appears in the CMAJ (Canadian Medical Association Journal).

COPD refers to a group of lung diseases in which the free flow of air is obstructed. Smoking is the most important risk factor associated with development of COPD. Once it develops, it cannot be completely reversed and symptoms progressively worsen with time. The main symptoms include productive cough and breathlessness.

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New Tool Predicts COPD Patient's at Risk of Serious Complications

Before the availability of the tool, it was difficult for doctors to accurately identify if a COPD patient with a sudden worsening of symptoms would have serious complications requiring admission or could be safely sent home.

Validating the Ottawa Risk Assessment Tool

The study was conducted across six hospitals in Alberta and Ontario on 1415 patients with COPD aged 50 years and above, who presented to the emergency roomwith sudden worsening of their symptoms. The doctors used the 10-point Ottawa COPD Risk Scale to identify patients who were at risk of serious complications including death.

The findings were as follows:
  • The 10-point tool rightly identified 135 patients (9.5%) who were at risk for serious
  • complications from their COPD
  • However, among 779 patients not admitted to hospital, 65 patients (8.3%) were found to be at increased risk of serious complications as well
Thus, the validation study suggests that the COPD tool can help doctors including emergency room physicians make correct decisions so that patients at risk are not wrongly discharged and sent home and those at risk are admitted and receive intensive care.

What is the 10-Point Ottawa COPD Risk Scale?

The 10-point Ottawa COPD Risk Scale was developed by Dr Ian Stiell, professor and renowned physician in the Ottawa Hospital and father of clinical decision rules who has enabled better patient care and outcomes. Among other rules, he has also developed the Ottawa Ankle Rules and the Canadian C-Spine Rule which is available as a smart phone App.

After analyzing nearly 20 clinical and laboratory parameters that could predict risk, the 10-point Ottawa COPD Risk Prediction tool was developed that included five parameters from patient's history, clinical examination and laboratory tests. These include:
  • History of previous intubation
  • Too sick to do a walk test
  • Heart 110/ min or more
  • Hemoglobin < 100 g/l
  • Urea > 12 mmol/l
These risk factors are simple and easy to assess, not expensive to perform and provide a quantitative estimation of risk that varied from 2.2 percent risk (patients who scored zero on the scale) to 91.4 percent risk of serious complications in persons who scored 10.

Scope of Study

  • Following clinical validation in this study, the tool can now be used to make decisions regarding admission or discharge of COPD patients
  • The tool can be easily used by family physicians, general practitioners, general and chest physicians as well as emergency room physicians
To conclude with the remarks of Dr Ian Stiell, noted professor of emergency medicine and senior scientist at the University of Ottawa, "This tool should help decrease unnecessary admissions as well as unsafe discharges of patients with COPD who should be admitted."

Reference :
  1. Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department - (DOI: https://doi.org/10.1503/cmaj.180232)

Source: Medindia

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