COPD decision tool helps keep patients safe

By Amelia Buchanan

Patients with chronic obstructive pulmonary disease (COPD) often come to the Emergency Department gasping for breath. These flare-ups can usually be treated safely in the ED, but sometimes they can lead to serious complications.

That’s why Dr. Ian Stiell created a decision tool to help doctors accurately predict which patients were the most likely to suffer complications.

A recent study published in CMAJ found that The Ottawa COPD Risk Scale is better than current practice at predicting these short-term risks. Now this made-in-Ottawa tool can be used by doctors around the world to help choose the best care for their patients with COPD.

“Before this tool, there was no way to know if a patient who came to the Emergency Department with a COPD flare-up was going to have serious complications,” said Dr. Stiell, also a senior scientist at The Ottawa Hospital and distinguished professor at the University of Ottawa. “This new information can help doctors decide whether to admit a patient or send them home.”

COPD is a group of diseases that block airways and affects 11 percent of Canadians over age 35. Flare-ups of the disease make it harder to breathe and can lead to complications like needing a breathing machine, or having a heart attack or death. However, identifying which patients will experience these complications is challenging. Dr. Stiell’s team previously found that about half of patients with COPD who suffer adverse events in Canada do so after being sent home. Until now, there has been little evidence to help prevent this.

“This tool will improve care for patients with COPD by helping ensure that those at high risk of dangerous complications are admitted to hospital, and those at low risk are sent home,” said Dr. Stiell.

Dr. Stiell noted that doctors consider many factors when deciding whether to admit a patient, including how much support they have at home and whether they can see a doctor within a week of their visit. The Ottawa COPD Risk Scale does not replace these considerations, but provides additional information to help doctors make a decision.

Dr. Stiell’s research team developed the tool based on data from 945 patients from Canadian hospitals. The 10-point scale includes elements from a patient’s history, examination or tests conducted during their visit. These risk factors are easy to determine and do not need expensive further testing.

A validation study with 1,415 more patients showed that using the risk scale is better than current practice. If used, it will likely increase COPD admissions for higher-risk patients while decreasing admissions of low-risk patients. Researchers don’t expect this tool to cause a net increase in COPD admissions overall.

“There’s no question that this tool can be used today,” said Dr. Stiell. “While designed for emergency physicians, it could also help others who serve patients with COPD, including respirologists, general internists and family doctors.”

Dr. Stiell is known around the world for creating decision rules that improve patient care, such as the Ottawa Ankle Rules and the Canadian C-Spine Rule. These rules are now available on a mobile app.

This study was funded by the Canadian Institutes of Health Research. Research like this is possible because of generous support for research to improve patient care at The Ottawa Hospital.

Amelia Buchanan is the Senior Communications Specialist at The Ottawa Hospital