Document Type : Original Article
Authors
1 Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
2 Emergency Care Promotion Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
3 Men‘s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
4 Department of Support and Services Management, Institute of Management and Organizational Resources, Policing Science and Social Studies Research Institute, Tehran, Iran
5 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
6 Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significant
healthcare burden. This study aimed to compare three risk assessment tools in predicting the
outcomes of COPD exacerbation.
Methods: This prospective cohort study was conducted between October 2023 and November
2024 at five hospitals in Iran (three in Tehran, one in Shahr-e-Rey, and one in Nehbandan). A total of
392 patients admitted with acute exacerbation of COPD were enrolled using consecutive sampling.
The predictive accuracy of the Ottawa COPD Risk Scale (OCRS), DECAF, and BAP-65 for adverse
outcomes (ICU admission, mechanical ventilation, and mortality) was assessed. The area under the
receiver operating characteristic curve (AUC-ROC) and performance metrics (sensitivity, specificity,
predictive values, and likelihood ratios) were calculated for each score. AUCs were compared using
paired sample ROC analysis with significance set at P<0.05.
Results: The AUCs for OCRS, DECAF, and BAP-65 in predicting cumulative adverse outcomes (CAO)
were 0.78 (95% CI: 0.73–0.83), 0.79 (95% CI: 0.74–0.83), and 0.79 (95% CI: 0.74–0.83), respectively
(P<0.05). For CAO, DECAF and BAP-65 demonstrated the most balanced performance at optimal
cutoff, with sensitivities of 69.8% (95% CI: 61.9–75.4) and 68.2% (95% CI: 59.7–75.6) and specificities
of 78.7% (95% CI: 0.74.5–0.81.8) and 78% (95% CI: 72.5–82.5). OCRS had a sensitivity of 61.2% (95%
CI: 52.6–0.77) and a specificity of 84.8% (95% CI: 80.3–89.5). No significant confounding or effect
modifications from demographics, lifestyle factors, or comorbidities were found except for age with
DECAF, which performed better in younger patients.
Conclusion: DECAF and BAP-65 showed the most balanced performances in predicting CAO
amongst the three tools. Paired with a clinician’s judgment, these tools offer valuable insights for
better triage and clinical decision-making in managing acute COPD exacerbation.
Keywords
Main Subjects
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