Some DECAF and a few PEARLs

22/09/2021 12:30 pm to 22/09/2021 2:00 pm

Event Details


** This event has now passed **


Prognostic tools are used in a wide range of clinical settings, but hitherto COPD was a neglected area. Such tools do not seek to replace clinical judgement, but rather to enhance this by providing an objective and accurate estimate of the risk of particular outcome. This provides a sound basis for truly informed shared decisions with patients, and improves selection for place and level of care, alongside other aspects of management.

In exacerbations of COPD triaged for admission, DECAF and PEARL are the best available predictors of risk of in-hospital death and post-discharge readmission respectively. A randomised controlled trial (RCT) has shown that hospital at home selected by low-risk DECAF score is safe, clinically and cost-effective, and preferred by 90% of patients.

Prof Stephen Bourke, Consultant in Respiratory Medicine and Honorary Professor, Newcastle University, will provide an overview of the evidence supporting the use of these tools and share existing clinical resources. Following the event, he and Dr Carlos Echevarria, Consultant in Respiratory and General Internal Medicine at Newcastle’s Royal Victoria Infirmary, will offer support to centres wishing to implement new services over the coming year.


The event will be of particular interest to respiratory physicians, respiratory specialist nurses, respiratory physios and pharmacists.


How can DECAF and PEARL be used?


Low risk DECAF 0-1:

  • Admission avoidance in A&E, if no additional acute care need. Avoiding unnecessary admissions and improving flow through the department.
  • Hospital at home: this provides care patients would normally receive in hospital, including 24/7 specialist support, controlled oxygen therapy if required, nebulised bronchodilators etc. There is the potential to extend this service to include exacerbations of bronchiectasis and pneumonia.
  • Early discharge: if 24/7 support is not an option, you can at least discharge low risk patients earlier.

High risk DECAF 3+:

  • Empirical antibiotic choice – median time to death in those who die is 2 days – one bite at the cherry.
  • Close monitoring. Specialist respiratory ward or higher level of care. Don’t board.

PEARL: selection for supported discharge services aiming to reduce readmission risk.



The PEARL score is a simple tool that can effectively stratify patients’ risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population.

The DECAF Score is a simple yet effective predictor of mortality in patients hospitalised with an exacerbation of COPD and has the potential to help clinicians more accurately predict prognosis, and triage place and level of care to improve outcome in this common condition.