Evaluating the Roth and Dyspnea severity score for emergency department discharge in exacerbations of chronic obstructive pulmonary disease

Abstract

Background: Exacerbations of chronic obstructive pulmonary disease (ECOPD) are a common reason for emergency department (ED) visits. It is of the utmost importance to make the right decisions regarding hospital admission or discharge for patients with ECOPD who present to the ED. This can sometimes be a complex matter. This study aimed to evaluate the diagnostic accuracy of the Roth score and Dyspnea Severity Score (DSS) in the decision-making process for discharging ECOPD patients from the ED. Methods: This prospective, multicenter diagnostic accuracy study was conducted in the EDs of three secondary-level state hospitals and one tertiary-level teaching and research hospital in Turkey. All patients who presented to the ED with ECOPD and did not meet the exclusion criteria were included in the study. A receiver operating characteristic (ROC) curve was created to determine the cutoff values for the Roth score and DSS in the discharge decision, and sensitivity and specificity were calculated. Results: A total of 352 patients were enrolled, comprising 286 males (81.3%) and 66 females (18.7%), with a median age of 69 years (IQR: 61–76). The area under the curve (AUC) for the discharge decision was 0.894 for the Roth Score (seconds), corresponding to a sensitivity of 87.4% and a specificity of 86.8% at a cutoff value of 9.95 (>). AUC for the discharge decision was 0.917 for the DSS, corresponding to a sensitivity of 88.9% and a specificity of 79.5% at a cutoff value of 5 (<). Conclusion: The Roth score and the DSS show high sensitivity in determining discharge decisions for patients with ECOPD presenting at the ED, thus offering a swift and pragmatic solution for discharge decisions. In daily practice, these tools provide reliable, non-invasive, and objective bedside cut-offs that can safely streamline patient disposition and reduce unnecessary resource utilization. Although the results are promising in terms of standardizing the use of the Roth score and the DSS in ECOPD, further research is required.