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.
