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    DECAF Score for Acute Exacerbation of COPD

    Predicts in-hospital mortality in acute COPD exacerbation.
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    INSTRUCTIONS

    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
    Pearls/Pitfalls
    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)
    0
    Too dyspneic to leave house but independent with washing/dressing (eMRCD 5a)
    +1
    Too dyspneic to leave house and wash/dress (eMRCD 5b)
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Increasing DECAF Scores correlate with increased risk for in-hospital mortality.
    • High risk DECAF Scores (3-6) are associated with both high risk of death and short time to death. Consider early escalation and higher level of monitoring versus palliative care for these patients.
    • Low risk DECAF Scores (0-1) are associated with low mortality risk and these patients may be candidates for early discharge.

    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 admitted patients with a primary diagnosis of an acute COPD exacerbation, not in the outpatient setting or in patients whose COPD is stable.
    • DECAF Scores 5–6 were found to have highest risk of death and shortest time to death, and may warrant early evaluation for escalation of care, higher level of monitoring, or potential palliative care.
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD
    About the Creator
    Dr. John Steer
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    Content Contributors
    Reviewed By
    • Robyn Scatena, MD