The Ottawa COPD Risk Scale (OCRS), its parts, and other clinical factors were evaluated for Emergency department (ED) disposition choices in a US population. In a retrospective cohort of ED patients with COPD exacerbations, researchers compared the OCRS and other variables in predicting SAEs. The primary outcome, SAE, was defined as any death, admission to a monitored unit, intubation, noninvasive ventilation, major surgery, myocardial infarction, or revisit with hospital admission during the 30-day follow-up period. A total of 246 patients (median age 61 years, 46% male, total admission rate toward 52%), with 46 (18.7%) having SAEs, were included in the study. The median OCRS scores of individuals with and without an SAE did not differ substantially (difference: 0 [interquartile range 0–1)). The OCRS has low accuracy in predicting SAEs (Hosmer-Lemeshow goodness of fit [H-L GOF] P≤.001, area underneath the receiver operating characteristic [ROC] curve 0.519). The Charlson comorbidity index (OR 1.3 [1.1–1.5] per 1-point increase), triage venous PCO2 (OR 1.7 [1.2–2.4] per 10 mm Hg increase), and hospitalization within the previous year (OR 9.1 [3.3–24.8]) were all significantly related to SAEs in our final model (H-L GOF P=.14, area under the ROC curve 0.808). In the population, the OCRS did not consistently predict SAEs. In the US ED sample, 3 risk factors were significantly linked with 30-day SAE: triage PCO2 level, Charlson comorbidity score, and hospitalization during the previous year. More research was needed to build generalizable decision tools for this patient population to increase safety and resource utilization.
Source –rc.rcjournal.com/content/67/1/56
