Ottawa COPD Risk Scale

Ottawa COPD Risk Scale
History of Coronary Artery Bypass Graft
Intervention for Peripheral Vascular Disease
Intubation for Respiratory Distress (ever)
HR ≥110 bpm on ED Arrival
Too Ill to Do Walk Test on ED Arrival
Acute Ischemic ECG Changes
Pulmonary Congestion on Chest X-Ray
Hemoglobin <100 g/L
Urea ≥12 mmol/L
Serum CO₂ ≥35 mEq/L
Ottawa COPD Score: –
Score: 0
Default scoring assumes 0 for un-set fields.
Predicts 30-day mortality or serious adverse events (MI, intubation, etc) in ED patients with COPD.

Why Use

Risk-stratifying patients with acute COPD exacerbation can allow for safer disposition decisions (i.e., avoid admitting patients suitable for discharge, and avoid discharging patients at risk for adverse event).

When to Use

Patients presenting to the ED with acute COPD exacerbation. Should not be applied in patients who are obviously too ill for discharge (e.g. hypotensive, severe dementia, ischemic chest pain, etc).

Formula

Addition of the selected points: Variable Points History Coronary bypass graft 1 Intervention for peripheral vascular disease 1 Intubation for respiratory distress (any history) 2 Examination HR ≥110/min (on arrival to ED) 2 Too ill to do walk test* after treatment in ED (SaO 2 <90% or HR ≥120/min) 2 Investigations Acute ischemic changes on EKG (by clinician judgment) 2 Pulmonary congestion on chest x-ray (by clinician judgment) 1 Hemoglobin <10 g/dL (100 g/L) 3 Urea ≥12 mmol/L (BUN ≥34 mg/dL) 1 Serum CO 2 ≥35 mEq/L (35 mmol/L) 1 *In the study, a structured 3 min walk test was performed with the patient walking at their own pace regardless of distance and their normal walking aids (but they could not be supported by another person).

Advice

Consider local practices when making disposition decisions. The study was conducted at 6 Canadian hospitals; in Canada, approximately 37.5% of emergency patients with COPD exacerbation, compared with 80% in the US ( Stiell 2014 ).

More Information

Interpretation: COPD Risk Scale Risk group Risk of adverse event* 0 Low 2.2% 1 Medium 4.0% 2 7.2% 3 High 12.5% 4 20.9% 5 Very high 32.9% 6 47.5% 7 62.6% 8 75.6% 9** - 10 91.4% >10** - *Defined as all-cause 30-day mortality or any of the following within 14 days of the index ED visit (regardless of whether patient was initially admitted): Admission to a monitored unit (excluding monitoring by telemetry). Intubation/need for noninvasive ventilation after hospital admission (unless already on home oxygen). MI, as defined by international consensus standards ( Alpert 2000 ). Major procedure ( CABG , PCI , other cardiac surgery, or new hemodialysis). Return to the ED for any related medical problem within 14 days, followed by hospital admission (if discharged after initial visit). **No patient had a score of 9 or >10.

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