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Calculator · COPD exacerbation — in-hospital mortality
DECAF score
UK-derived, and unusually good at what it does: it identifies the COPD exacerbation that is going to die in this admission, which the way someone looks at the front door often does not.
What it asks
| Criterion | Points |
|---|---|
| Extended MRC dyspnoea, when stable eMRCD 5a — too breathless to leave the house, independent for washing AND dressing. 5b — dependent for either. | eMRCD 1 – 4 — 0 eMRCD 5a — 1 eMRCD 5b — 2 |
| Eosinopenia — eosinophils < 0.05 ×10⁹/L | No — 0 Yes — 1 |
| Consolidation on chest X-ray | No — 0 Yes — 1 |
| Acidaemia — pH < 7.30 | No — 0 Yes — 1 |
| Atrial fibrillation On the ECG now, or a documented history | No — 0 Yes — 1 |
How to read the score
| Score | Means | What to do |
|---|---|---|
| 0–1 | Low risk | In-hospital mortality around 1–3%. Candidates for early supported discharge, where your trust has that service. |
| 2 | Intermediate risk | Around 5%. Admit and treat; reassess rather than assume improvement. |
| 3–6 | High risk | 15–50% in-hospital mortality, rising steeply across the band. Escalate early, and have the ceiling-of-care conversation now rather than at 3am. |
Before you use it
Derived and validated at ADMISSION for an exacerbation of COPD — not for undifferentiated breathlessness, not for asthma, and not as a repeated observation. Eosinopenia is easy to miss because nobody looks at the differential; it is one of the five and it is doing real work. A high score is a reason to escalate, and a reason to talk about what escalation should look like for this person — not a reason to give up.
Source: Steer, Gibson & Bourke, Thorax 2012
Checked, and shown
Every threshold on this page was checked against its primary source by a practising doctor. Here is what that involved, and what it found.