Clinical Prognostic Tools And Their Use In Copd

Introduction: Simple statistical models outperform expert opinion in a wide range of fields. Clinical prognostic tools are available to guide care in COPD exacerbation (ECOPD) including admission avoidance, early discharge & palliative care planning. Little is known about their actual use in clinical practice. Methods: A survey, examining structure of care and the use of prognostic scores, was distributed to 196 hospitals on the UK Royal College of Physicians COPD audit program mailing list in 2017 and repeated in 2019. Nine well-known tools were specified with the freedom to include others. Results: Most units still rely on clinical judgement, but use of DECAF & PEARL doubled for admission avoidance/ unsupported discharge and tripled for Hospital at home(HaH)/Early Supported Discharge(ESD) (see table). Tools were also used in other areas such as escalation decisions, outpatient monitoring and transplantation referrals. Discussion: Use of prognostic scores has increased, but further work is needed to embed this within clinical practice. PEARL/DECAF were most commonly used. DECAF safely & effectively identified low mortality risk patients for HaH in the only implementation study to date.1 In palliative care there has been a fall in use of tools, highlighting the need for further studies exploring barriers to their use in clinical care. 1. Echevarria, Thorax 2018