Does higher DECAF score increase length of hospital stay in acute exacerbation of COPD?

Abstract

Background: Dyspnoea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) Score is an effective clinical prediction tool used in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Scores of 0-1:low risk, 2:Intermediate risk and 3-6:High risk. This scoring system is easy to use and performed better than existing tools. Hypothesis: Patients with AECOPD and high DECAF score have longer hospital stay. Method: Patients admitted to respiratory wards with AECOPD between Dec 2014 to Feb 2015 were prospectively reviewed and DECAF score applied to each patient. Length of hospital stay(LOS) was then correlated with total DECAF scores and each predictive index. Results: Out of 78 total admissions, 66 were reviewed as 12 patients died. 64% were male, mean age was 71.6 years and average LOS of 15.1 days. LOS highest in those with DECAF scores of 3-5 (16.7 days) and lowest in those with scores of 0-1 (12 days). LOS with an eMRC dyspnoea score of 5A/5B was 16.1 days, eosinopenia was 17.6 days and acidemia was 20.1 days. Also LOS increased with each DECAF score. Conclusions: LOS depends on multiple factors like functional status, exacerbation severity, co-morbidities and availability of health and social care. Patients with high DECAF scores were generally more unwell and have longer recovery period. Once suitable these patients should be discharged with help of early supported discharge teams.