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    DECAF Score for Acute Exacerbation of COPD

    Predicts in-hospital mortality in acute COPD exacerbation.


    Use in patients ≥35 years old, hospitalized with a primary diagnosis of acute exacerbation of COPD. Do not use in patients with comorbidity expected to limit survival <12 months.

    When to Use
    Why Use

    Patients hospitalized with a primary diagnosis of acute exacerbation of COPD as follows:

    • ≥35 years old.
    • With or without pneumonia.
    • Preadmission evidence of airflow obstruction on spirometry (FEV₁/FVC <0.70).
    • ≥10 pack-year smoking history.

    Do not use if patient has <12 months life expectancy or is on home O₂.

    • The DECAF Score predicts in-hospital mortality in patients admitted to the hospital with acute exacerbation of COPD.
    • Can be used in patients who have evidence of both pneumonia and COPD.
    • Better predictor of in-hospital mortality than CURB-65 in patients who have both pneumonia and an acute exacerbation of COPD.
    • Uses routinely available variables.
    • Variables from initial labs are used to calculate the score.
    • Requires Extended Medical Research Council Dyspnea (eMRCD) score, which may be difficult to obtain in patients with acute encephalopathy, dementia, or those who are intubated.
    • Validated for use at the time of admission in UK hospitals, but not yet validated in US EDs.
    • May assist clinical decision-making in terms of early discharge, escalation of care, or discussion of goals of care:
      • Low risk (score 0-1) patients may be appropriate for early supported discharge.
      • High risk (score 3-6) patients may be appropriate for higher levels of care and/or addressing goals of care.
    • Higher scores may correlate with increased length of stay.
    Not too dyspneic to leave house (eMRCD 1–4)
    Too dyspneic to leave house but independent with washing/dressing (eMRCD 5a)
    Too dyspneic to leave house and wash/dress (eMRCD 5b)
    Confirmed positive
    Confirmed negative


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    Next Steps
    Creator Insights
    Dr. John Steer

    From the Creator

    Why did you develop the DECAF Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    Exacerbations of COPD (ECOPD) disrupt patients' lives, are a very common reason for hospital admission and have a significant in-hospital mortality rate. Clinicians' estimates of prognosis in patients hospitalized with ECOPD are frequently inaccurate. We developed the DECAF score because a simple, reliable, accurate prediction tool could potentially improve patient care, by identifying patients suitable for hospital discharge or for more intensive therapy / monitoring.

    What pearls, pitfalls and/or tips do you have for users of the DECAF Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    DECAF is simple to calculate and apply at the bedside. It requires an assessment of the patient’s usual level of breathlessness and function: the eMRCD score. Errors can be made by misclassification of the eMRCD. eMRCD records an individual's level of breathlessness when they are stable; i.e., "on a good day, during the preceding 3 months."

    In summary, eMRCD 5a is defined by an individual who is "Too breathless to leave their house unassisted but independent in washing and/or dressing"; eMRCD 5b indicates a patient who is "Too breathless to leave the house unassisted and requires help with washing and dressing." Simple walking aids do not constitute assistance but wheelchairs and mobility scooters do.

    How do you use the DECAF Score in your own clinical practice?

    To identify low risk patients (DECAF 0-1) who are suitable for hospital at home or early supported discharge. We have performed an RCT of Hospital at Home versus usual care, with patient selection by DECAF Score. This is awaiting publication.

    Can you give an example of a scenario in which you use it?

    To identify high risk patients that may need dual antibiotics and early input from critical care, with close monitoring.

    What score do you assign to patients who cannot complete the eMRCD (intubated, demented, acute encephalopathy)?

    The eMRCD score refers to the level of activity from the past three months. Therefore, we would assess the eMRCD using information obtained from: recent outpatient clinic records; patient relatives, carers or friends; or the patient's primary care practitioner.

    About the Creator

    John Steer, MBChB, PhD, is a physician in the department of respiratory medicine at North Tyneside General Hospital in North Shields, UK. He is also a member of the Respiratory Medicine Research Group at North Tyneside General Hospital. Dr. Steer's research interests include COPD, ventilation, and quality of life.

    To view Dr. John Steer's publications, visit PubMed

    Are you Dr. John Steer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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