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    BAP-65 Score for Acute Exacerbation of COPD

    Predicts mortality in acute COPD exacerbation.
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    INSTRUCTIONS

    Use in patients >40 years of age presenting to the emergency department with acute COPD exacerbation. Use the worst variables on the day of admission.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients >40 years of age presenting to the emergency department with acute COPD exacerbation. Do not use in patients ≤40 years old, as asthma is a confounder in this population.

    • Does not require COPD-specific information such as FEV₁ or 6 Minute Walk Test.
    • Variables are easily obtained at the time of presentation. Only requires one laboratory value.
    • Excludes patients who had an alternative primary diagnosis other than acute COPD exacerbation.
    • May predict need for mechanical ventilation within 48 hours of admission.
    • Based on data from ICD-9 and DRG codes, which may be imprecise and may lead to coding bias or up-coding.
    • Both internal and external validation were completed in retrospective cohorts of patients from a research database.
    • May assist in clinical decision-making to risk-stratify patients to a higher level of care, or potentially observation or early discharge.
      • Higher scores predict which patients may require mechanical ventilation, and these patients may be appropriate for higher level of care.
      • Lower scores predict which patients may not require mechanical ventilation and have low in-hospital mortality, and these patients may be appropriate for observation or early discharge.
    • With higher scores, there may be higher in-hospital mortality, risk of mechanical ventilation, length of stay, and cost.
    • The DECAF Score is an alternative that can be used to calculate in-hospital mortality for patients admitted to the hospital with an acute COPD exacerbation and may outperform BAP-65 in this regard.
    About the Creator
    Dr. Andrew Shorr
    Content Contributors
    • Akhil Khosla, MD
    • Robyn Scatena, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Consider early non-invasive ventilation and/or ICU care in patients with higher in-hospital mortality.
    • May predict the need for mechanical ventilation within 48 hours, and these patients should be considered for higher level of care to provide non-invasive and/or invasive ventilation.
    • There may be a role for early discharge or observation in lower BAP-65 classes.

    Management

    Was not studied to dictate management or treatment options. The score should not replace clinical judgment regarding workup, diagnosis, or treatment.

    Critical Actions

    • Should only be used in patients presenting to the ED with a primary diagnosis of an acute COPD exacerbation, not in the outpatient setting or in patients whose COPD is stable.
    • BAP-65 class V have the highest risk of in-hospital mortality and need for mechanical ventilation, and these patients should be closely monitored.

    Formula

    Addition of the selected points, then class assigned by age:

     

    0 points

    1 point

    BUN ≥25 mg/dL (8.9 mmol/L)

    No

    Yes

    Altered mental status*

    No

    Yes

    Pulse ≥109 beats/min

    No

    Yes

    Class

    BAP

    Age

    I

    0

    <65 years

    II

    0

    ≥65 years

    III

    1

    Any age

    IV

    2

    Any age

    V

    3

    Any age

    *Initial GCS<14, or disorientation, stupor, or coma as determined by physician.

    Facts & Figures

    Interpretation:

    BAP-65 Class

    In-hospital mortality

    Need for mechanical ventilation within 48 hours

    Recommendation

    I

    0.3%

    0.3%

    Routine management of COPD exacerbation

    II

    1.0%

    0.2%

    III

    2.2%

    1.2%

    Consider early non-invasive ventilation and/or ICU care

    IV

    6.4%

    5.5%

    V

    14.1%

    12.4%

    Data from validation cohort in Tabak 2009.

    Evidence Appraisal

    The original BAP-65 Score was derived by examining a cohort of 88,074 patients from the Cardinal Health Clinical Outcomes Research Database. Patients studied were >40 years of age, with a primary/principal discharge diagnosis of acute exacerbation of COPD (using ICD-9 codes). Patients with a primary diagnosis of acute respiratory failure and secondary diagnoses of acute exacerbation of COPD were excluded. The authors selected four variables with the highest discriminative power for mortality to create the BAP-65 Score. The original study was internally validated, and a separate cohort in the same database was used as an additional validation.

    The BAP-65 was also externally validated in a retrospective cohort of 34,669 patients using a different database than the original study. In the external validation, patients with a primary diagnosis of acute respiratory failure were also included (in the original study, these patients were excluded). The external validation found that BAP-65 correlates well with in-hospital mortality, need for mechanical ventilation, length of stay, and cost.

    Dr. Andrew Shorr

    About the Creator

    Andrew Shorr, MD, MPH, is an associate director of pulmonary and critical care medicine and the chief of the Pulmonary Clinic at MedStar Washington Hospital Center in Washington, DC. Dr. Shorr's research interests include resistant pathogens and healthcare-associated bacteremia, and he has published more than 140 original studies.

    To view Dr. Andrew Shorr's publications, visit PubMed

    Content Contributors
    • Akhil Khosla, MD
    • Robyn Scatena, MD