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The Korean Journal of Critical Care Medicine > Volume 28(4); 2013 > Article
The Korean Journal of Critical Care Medicine 2013;28(4): 255-265.
doi: http://dx.doi.org/10.4266/kjccm.2013.28.4.255
만성폐쇄성폐질환의 급성 악화로 응급실에 내원한 환자에서 DECAF 점수의 유용성
손지형⋅이장영⋅양영모⋅성원영⋅서상원⋅김진철*⋅이원석
을지대학교 의과대학 응급의학과, *을지대학교병원 응급의학과
Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Ji Hyoung Son, Jang Young Lee, Young Mo Yang, Won Young Sung, Sang Won Seo, Jin Cheol Kim, Wonsuk Lee
1Department of Emergency Medicine, Eulji University, Daejeon, Korea. medulla@eulji.ac.kr
2Department of Emergency Medicine, Eulji University Hospital, Daejeon, Korea.
ABSTRACT
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department. METHODS: Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital. RESULTS: The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001). CONCLUSIONS: The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.
Key Words: chronic obstructive; emergencies; pulmonary disease
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