A comparison of the DECAF score and NEWS2 to predict inpatient death in patients with COPD exacerbation
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Authors
Steer, John
Bourke, Stephen
Issue Date
2018
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Abstract
Introduction: The DECAF score accurately predicts death in patients hospitalised with COPD exacerbation. It is superior to other prognostic scores and can be used to guide treatment, such as identifying low risk patients for Hospital at Home.1 The National Early Warning System was updated in December 2017 (NEWS2), and takes into account patients at risk of hypercapnic respiratory failure who require lower target oxygen saturations. The prognostic benefit of admission NEWS2 in comparison to DECAF has not been examined. Whilst the function of NEWS2 is different from DECAF, if admission NEWS2 were as good or better at risk prediction than DECAF then the principle of parsimony would favour its use.
Methods: The DECAF score and the original NEWS indices were collected in consecutive admissions of patients with COPD exacerbation (n=2,645) in derivation, internal validation and external validation cohorts from six UK hospitals. COPD was confirmed with spirometry, and an exacerbation was based on GOLD criteria. The original NEWS indices were re-coded to the NEWS2 scoring system, and its discrimination was assessed using the area under the receiver operator curve. DECAF and NEWS2 were compared using the method of Delong. Missing data were imputed using multiple imputation.
Results: For in-hospital mortality prediction, DECAF was superior to admission NEWS2 across all three cohorts, and was more consistent between cohorts. Overall, DECAF offered more clinically useful risk stratification: low risk DECAF=1.2%, NEWS2=3.5%; moderate risk DECAF=6.4%, NEWS2=5.6%; high risk DECAF=25.5%, NEWS2=15.4%.
Discussion: Assessment of in-hospital mortality risk on admission for COPD exacerbation should inform clinical care. Admission NEWS2 showed variable and at best modest performance in different cohorts, which does not support its adoption for this purpose. DECAF offers excellent and consistent prediction of inpatient mortality, and clinically and cost-effective selection for Hospital at Home.1 This supports retention of DECAF for this purpose. These results do not detract from use of repeated measures of NEWS2 during admission for its intended purpose of identifying deteriorating patients.
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Citation
Echevarria, C., Steer, J., Bourke, S. (2018) A comparison of the DECAF score and NEWS2 to predict inpatient death in patients with COPD exacerbation. Thorax; 73 : A29.
Publisher
Thorax
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ISSN
1468-3296