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    Patent Pending

    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.
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    41-64
    ≥65

    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.
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD
    About the Creator
    Dr. Andrew Shorr
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD