Tool identifies which patients with COPD are at risk of death, serious complications

A new decision tool to help emergency physicians identify patients with chronic obstructive pulmonary disease (COPD) who are at high risk of serious complications, including death, performs better than current practice, according to a validation study of the Ottawa COPD Risk Scale in CMAJ (Canadian Medical Association Journal).

"Before this tool, there was no way to know if a patient who came to the emergency department with a COPD flare-up was going to have dangerous complications," says Dr. Ian Stiell, distinguished professor of emergency medicine at the University of Ottawa and a senior scientist at The Ottawa Hospital. "This new information can help doctors decide whether to admit a patient or send them home."

Chronic obstructive pulmonary disease, mainly caused by smoking, is a common condition that affects breathing and worsens over time.

The study was conducted at six hospitals in Ontario and Alberta with 1415 patients aged 50 years and older who presented at emergency departments with COPD flare-ups. Using the 10-point Ottawa COPD Risk Scale, researchers tested whether they could accurately predict short-term serious complications in these patients. The tool correctly predicted that 135 patients (9.5%) would have serious complications, although 65 (8.3%) of serious outcomes occurred in the 779 participants who were not admitted to hospital.

"As this risk scale has been clinically validated, it can now be used to estimate medical risk and help with decisions about patient discharge or admission," says Dr. Stiell. "This should help decrease unnecessary admissions as well as unsafe discharges of patients with COPD who should be admitted."

The Ottawa COPD Risk Scale can be used by respirologists, general internists and family doctors who care for patients with COPD, in addition to emergency physicians.

Dr. Stiell is world-renowned for creating decision rules that improve patient care, including the Ottawa Ankle Rules and the Canadian C-Spine Rule, now available on a mobile app.

"Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department" is published December 3, 2018.