title: Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: comparing the CURB-65 and BAP-65 scores.
abstract: OBJECTIVE
  Clinicians lack a validated tool for risk stratification for need for mechanical ventilation (MV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to compare 2 risk scores, BAP-65 and CURB-65, at predicting a need for MV in AECOPDs.
  
  
  METHODS
  We analyzed 34,478 AECOPD admissions to 195 US hospitals (2007). We compared the rates of MV at admission and at any point during hospitalization based on the respective BAP-65 and CURB-65 scores. We compared the accuracy of the 2 scores via the area under the receiver operating characteristic curves.
  
  
  RESULTS
  The overall MV rate at admission was 7.9%, and the rate of MV any time equaled 9.3%. Use of MV increased with escalating BAP-65 and CURB-65 scores. The area under the receiver operating characteristic curve for BAP-65 was higher than that for CURB-65 for both early MV, 0.81 (95% confidence interval [CI], 0.80-0.82) vs 0.76 (95% CI, 0.75-0.77), P < .0001, and MV any time, 0.78 (95% CI, 0.77-0.79) vs 0.74 (95% CI, 0.73-0.75), P < .0001.
  
  
  CONCLUSIONS
  BAP-65 identifies patients with AECOPD at high risk for need of MV more accurately than does CURB-65. BAP-65 may represent a useful tool for initial MV risk stratification in AECOPD.
authors.affiliation: Pulmonary and Critical Care Medicine Washington Hospital Center, NW Washington, DC 20010, USA. andrew.shorr@gmail.com
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Sun
authors.forename: Richard S
authors.initials: RS
authors.lastname: Johannes
authors.forename: Karen G
authors.initials: KG
authors.lastname: Derby
authors.forename: Ying P
authors.initials: YP
authors.lastname: Tabak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States