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

Highlights:

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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‘The 10-point Ottawa COPD Risk Scale may help doctors to make better decisions regarding COPD patients so that high-risk cases are admitted and those at low risk of serious complications can be discharged.’
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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.

Chronic Obstructive Pulmonary Disease
COPD includes respiratory tract disorders that cause obstruction to airflow. These are chronic bronchitis, emphysema and small airway disease.

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 :

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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