The DECAF score is a clinical prediction tool used for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) that predicts in-hospital mortality. It consists of five components: Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation. Higher DECAF scores correlate with increased risk of in-hospital death. The score can help determine a patient's risk level and appropriate care, such as early discharge for low-risk patients or palliative care for high-risk patients.
1. DECAF Score for AECOPD
DR. MD. SHAFIQUL ISLAM DEWAN
RESIDENT (PHASE-B)
DEPARTMENT OF RESPIRATORY MEDICINE
DHAKA MEDICAL COLLEGE HOSPITAL
4/27/2023 1
2. DECAF Score
DECAF Score is an effective clinical prediction tool used in patients
with acute exacerbation of chronic obstructive pulmonary disease
(AECOPD) which Predicts in-hospital mortality in acute COPD
exacerbation.
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 2
3. Component of DECAF score
D - Dyspnoea
E - Eosinopenia
C - Consolidation
A - Acidemia
F - Atrial Fibrillation
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 3
4. When to Use
Patients hospitalized with a primary diagnosis of acute exacerbation
of COPD and have following criteria:
≥35 years old.
With or without pneumonia.
Preadmission evidence of airflow obstruction on spirometry (FEV₁/FVC <0.70).
≥10 pack-year smoking history.
Do not use if patient has <12 months life expectancy or is on home O₂.
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 4
5. Why Use
May assist clinical decision-making in terms of early discharge,
escalation of care, or discussion of goals of care:
Low risk (score 0-1) patients may be appropriate for early supported discharge.
High risk (score 3-6) patients may be appropriate for higher levels of care and/or
addressing goals of care.
Higher scores may correlate with increased length of stay.
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 5
8. Decision
Increasing DECAF Scores correlate with increased risk for in-hospital
mortality.
High risk DECAF Scores (3-6) are associated with both high risk of death
and short time to death. Consider early escalation and higher level of
monitoring versus palliative care for these patients.
Low risk DECAF Scores (0-1) are associated with low mortality risk and
these patients may be candidates for early discharge.
Intermediate risk DECAP Scores (2): Use clinician judgment for
management.
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 8
9. Pearls/Pitfalls
The DECAF Score predicts in-hospital mortality in patients admitted to the hospital with acute
exacerbation of COPD.
Can be used in patients who have evidence of both pneumonia and COPD.
Better predictor of in-hospital mortality than CURB-65 in patients who have both pneumonia
and an acute exacerbation of COPD.
Uses routinely available variables.
Variables from initial labs are used to calculate the score.
Requires Extended Medical Research Council Dyspnea (eMRCD) score, which may be difficult to
obtain in patients with acute encephalopathy, dementia, or those who are intubated.
Validated for use at the time of admission in UK hospitals, but not yet validated in US EDs.
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 9
10. 4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 10