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Establishing Criteria for Pulmonary Exacerbation Based on Severity Score in Adult Cystic Fibrosis Patients FREE TO VIEW

Venkatkiran Kanchustambham, MD; Gwen Pendleton, BSN; Walter Gribben, MD; Ravi Nayak, MD
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Saint Louis University Hospital, St Louis, MO

Chest. 2013;144(4_MeetingAbstracts):584A. doi:10.1378/chest.1702693
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SESSION TITLE: Cystic Fibrosis/ Bronchiectasis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: In Cystic Fibrosis (CF) patients pulmonary exacerbation (PEx) is considered as an important indicator of outcomes in clinical trials, quality of care and progression of disease. Yet there exists no standard definition of PEx. We are conducting an ongoing QI project to establish criteria for PEx based on pulmonary exacerbation score (PES) to define mild, moderate and severe exacerbation for use in clinical decision making and standardization of care to improve clinical outcomes in patient care at our CF clinic.

METHODS: Subjects are adult CF patients seen at Saint Louis University hospital CF clinic from November 2012. Using the literature on PEx, we have adopted the 14 element scoring system used at Akron Children's Hospital that consists of systemic signs and symptoms, pulmonary signs and symptoms and objective measurements (fev1, cxr and spo2) and is administered at every CF clinic visit. A threshold PES for the presence of PEx was based on available medical literature and adopted from Akron Children's Hospital. PES of ≥5 was defined as presence of PEx and treatment with either oral or IV antibiotics were recommended. Mild, moderate and severe PEx were defined as PES ranging from 5-7, 8-10 and >10 respectively.

RESULTS: This is an ongoing study and intended duration is 12 months. Until 3/28/13, we have 59 clinic visits. PES was calculated during all visits representing #100% utilization rates. Of these 21 patients had PES≥5 representing 35.6% and thus met the criteria for PEx. Of these 21 patients, 16 were treated with antibiotics representing 76.2% adherence to advice to treat with antibiotics for PES≥5. Of these 16, 8(38%) received oral antibiotics and 8(38%) received iv antibiotics. One pt refused IV antibiotics secondary to financial constraints. Outcomes of interests are change in FEV1, antibiotic use, hospitalization rates, before and after the implementation of the PES program. We intend to incorporate the PES into our clinic visit record and make it a standard of care.

CONCLUSIONS: This is an ongoing study with intended duration of 12 months. We intend to show that establishing criteria for PEx based on severity scoring will result in common and standardized approach among our CF clinicians resulting in Improved FEV1, reduced hospitalizations, timely use of antibiotics and enable us to compare effect of various interventions on outcomes.

CLINICAL IMPLICATIONS: Establishing criteria for PEx based on severity scoring will result in improved clinical outcomes.

DISCLOSURE: The following authors have nothing to disclose: Venkatkiran Kanchustambham, Gwen Pendleton, Walter Gribben, Ravi Nayak

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