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

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.

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., Speed, K., Menon, M., Daws, J., Dyson, J., Marsh, C., & 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. https://doi.org/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
• 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
• Contract Date: Nov 6, 2018