BAP-65 Score for Acute Exacerbation of COPD
Why Use
May assist in clinical decision-making to risk-stratify patients to a higher level of care, or potentially observation or early discharge. Higher scores predict which patients may require mechanical ventilation, and these patients may be appropriate for higher level of care. Lower scores predict which patients may not require mechanical ventilation and have low in-hospital mortality, and these patients may be appropriate for observation or early discharge. With higher scores, there may be higher in-hospital mortality, risk of mechanical ventilation, length of stay, and cost. The DECAF Score is an alternative that can be used to calculate in-hospital mortality for patients admitted to the hospital with an acute COPD exacerbation and may outperform BAP-65 in this regard.
When to Use
Patients >40 years of age presenting to the emergency department with acute COPD exacerbation. Do not use in patients ≤40 years old, as asthma is a confounder in this population.
Formula
Pearls / Pitfalls
Does not require COPD-specific information such as FEV₁ or 6 Minute Walk Test . Variables are easily obtained at the time of presentation. Only requires one laboratory value. Excludes patients who had an alternative primary diagnosis other than acute COPD exacerbation. May predict need for mechanical ventilation within 48 hours of admission. Based on data from ICD-9 and DRG codes, which may be imprecise and may lead to coding bias or up-coding. Both internal and external validation were completed in retrospective cohorts of patients from a research database.
Management
Was not studied to dictate management or treatment options. The score should not replace clinical judgment regarding workup, diagnosis, or treatment.
Critical Actions
Should only be used in patients presenting to the ED with a primary diagnosis of an acute COPD exacerbation, not in the outpatient setting or in patients whose COPD is stable. BAP-65 class V have the highest risk of in-hospital mortality and need for mechanical ventilation, and these patients should be closely monitored.
Advice
Consider early non-invasive ventilation and/or ICU care in patients with higher in-hospital mortality. May predict the need for mechanical ventilation within 48 hours, and these patients should be considered for higher level of care to provide non-invasive and/or invasive ventilation. There may be a role for early discharge or observation in lower BAP-65 classes.
More Information
Interpretation: BAP-65 Class In-hospital mortality Need for mechanical ventilation within 48 hours Recommendation I 0.3% 0.3% Routine management of COPD exacerbation II 1.0% 0.2% III 2.2% 1.2% Consider early non-invasive ventilation and/or ICU care IV 6.4% 5.5% V 14.1% 12.4% Data from validation cohort in Tabak 2009 .