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Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: A cross-section

Faisal, Muhammad; Scally, Andrew J.; Jackson, Natalie; Richardson, Donald; Beatson, Kevin; Howes, Robin; Speed, Kevin; Menon, Madhav; Daws, Jeremey; Dyson, Judith; Marsh, Claire; Mohammed, Mohammed A.

Authors

Muhammad Faisal

Andrew J. Scally

Natalie Jackson

Donald Richardson

Kevin Beatson

Robin Howes

Kevin Speed

Madhav Menon

Jeremey Daws

Judith Dyson

Claire Marsh

Mohammed A. Mohammed



Abstract

Objectives There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions.

Design Logistic regression model development and external validation study.

Setting Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data).

Participants Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission.

Results The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00).

Conclusions We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Citation

Faisal, M., Scally, A. J., Jackson, N., Richardson, D., Beatson, K., Howes, R., …Mohammed, M. A. (2018). Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: A cross-sectional study. BMJ open, 8(12), e022939. doi:10.1136/bmjopen-2018-022939

Journal Article Type Article
Acceptance Date Oct 16, 2018
Online Publication Date Dec 6, 2018
Publication Date Dec 6, 2018
Deposit Date Nov 6, 2018
Publicly Available Date Dec 13, 2018
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 12
Article Number e022939
Pages e022939
DOI https://doi.org/10.1136/bmjopen-2018-022939
Keywords Computer aided risk score; Hospital mortality; Vital signs and blood test; National early warning score; Emergency admission
Public URL https://hull-repository.worktribe.com/output/1145881
Publisher URL https://bmjopen.bmj.com/content/8/12/e022939

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