18 We present temporal and geographical validation of the DECAF

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pandora jewelry Acute exacerbations of COPD (AECOPD) account for one in eight hospital admissions,1 and are associated with worsening symptoms, lung function, health related quality of life, and mortality risk.2 6 Inhospital mortality is reported to be between 4.4% and 7.7%.7 10 Clinicians are unable accurately to predict prognosis in patients hospitalised with AECOPD.11 A robust prediction tool, which stratifies patients according to mortality risk, may help inform management, including Hospitalat Home (HAH) or early supported discharge (ESD) for low risk groups, and early escalation or appropriate palliation for high riskroutinely available on admission.12 The score comprises five predictors, the strongest of which is stable state dyspnoea, as measured by the extended MedicalResearch Council Dyspnoea score (eMRCD; table 1).13View this table:In this windowIn the derivation study (the original study, in which the DECAF score was developed), DECAF showed strong performance andwas superior to other tools designed or proposed for patients with AECOPD https://www.pandoracharmscanada.ca/,12 namely APACHE II,14 BAP 65,15 CAPS16 and CURB 65.17The 2014 UK National COPD audit recommended that the DECAF score be documented on all patients admitted with an AECOPD butnoted that validation was required,7 which is essential to prove the generalisability of a prognostic score.18 We present temporal and geographical validation of the DECAF score and re examine its predictive performance for short andmedium term mortality in a large multicentre cohort of patients hospitalised with AECOPD. Two cohorts are presented: the internalvalidation cohort assesses performance of DECAF in both hospitals from the original derivation study, but over a differenttime period; the external validation study assesses the performance and generalisability of DECAF in four hospitals from differentgeographical areas. Since the DECAF score could identify low risk patients (DECAF 0 1) who might benefit from HAH or ESD schemes,we report a detailed analysis of this subgroup.Study design and participationSix UK hospitals participated between January 2012 and May 2014 pandora jewelry.


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