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

6. Formula
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 6

7. Interpretation
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 7

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

11. Thank You
4/27/2023 DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 11