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A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk
OBJECTIVES: To compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission. DESIGN: A prospective study. SETTING: Consecutive emergency medic...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589037/ https://www.ncbi.nlm.nih.gov/pubmed/31221885 http://dx.doi.org/10.1136/bmjopen-2018-027741 |
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author | Faisal, Muhammad Khatoon, Binish Scally, Andy Richardson, Donald Irwin, Sally Davidson, Rachel Heseltine, David Corlett, Alison Ali, Javed Hampson, Rebecca Kesavan, Sandeep McGonigal, Gerry Goodman, Karen Harkness, Michael Mohammed, Mohammed |
author_facet | Faisal, Muhammad Khatoon, Binish Scally, Andy Richardson, Donald Irwin, Sally Davidson, Rachel Heseltine, David Corlett, Alison Ali, Javed Hampson, Rebecca Kesavan, Sandeep McGonigal, Gerry Goodman, Karen Harkness, Michael Mohammed, Mohammed |
author_sort | Faisal, Muhammad |
collection | PubMed |
description | OBJECTIVES: To compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission. DESIGN: A prospective study. SETTING: Consecutive emergency medical admissions in York hospital. PARTICIPANTS: Elderly medical admissions in one ward were assigned a risk of death at the first post-take ward round by consultant staff over a 2-week period. The consultant medical staff used the same variables to assign a risk of death to the patient as the CARM (age, sex, National Early Warning Score and blood test results) but also had access to the clinical history, examination findings and any immediately available investigations such as ECGs. The performance of the CARM versus consultant medical judgement was compared using the c-statistic and the positive predictive value (PPV). RESULTS: The in-hospital mortality was 31.8% (130/409). For patients with complete blood test results, the c-statistic for CARM was 0.75 (95% CI: 0.69 to 0.81) versus 0.72 (95% CI: 0.66 to 0.78) for medical judgements (p=0.28). For patients with at least one missing blood test result, the c-statistics were similar (medical judgements 0.70 (95% CI: 0.60 to 0.81) vs CARM 0.70 (95% CI: 0.59 to 0.80)). At a 10% mortality risk, the PPV for CARM was higher than medical judgements in patients with complete blood test results, 62.0% (95% CI: 51.2 to 71.9) versus 49.2% (95% CI: 39.8 to 58.5) but not when blood test results were missing, 50.0% (95% CI: 24.7 to 75.3) versus 53.3% (95% CI: 34.3 to 71.7). CONCLUSIONS: CARM is comparable with medical judgements in discriminating in-hospital mortality following emergency admission to an elderly care ward. CARM may have a promising role in supporting medical judgements in determining the patient’s risk of death in hospital. Further evaluation of CARM in routine practice is required. |
format | Online Article Text |
id | pubmed-6589037 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65890372019-07-05 A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk Faisal, Muhammad Khatoon, Binish Scally, Andy Richardson, Donald Irwin, Sally Davidson, Rachel Heseltine, David Corlett, Alison Ali, Javed Hampson, Rebecca Kesavan, Sandeep McGonigal, Gerry Goodman, Karen Harkness, Michael Mohammed, Mohammed BMJ Open Health Services Research OBJECTIVES: To compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission. DESIGN: A prospective study. SETTING: Consecutive emergency medical admissions in York hospital. PARTICIPANTS: Elderly medical admissions in one ward were assigned a risk of death at the first post-take ward round by consultant staff over a 2-week period. The consultant medical staff used the same variables to assign a risk of death to the patient as the CARM (age, sex, National Early Warning Score and blood test results) but also had access to the clinical history, examination findings and any immediately available investigations such as ECGs. The performance of the CARM versus consultant medical judgement was compared using the c-statistic and the positive predictive value (PPV). RESULTS: The in-hospital mortality was 31.8% (130/409). For patients with complete blood test results, the c-statistic for CARM was 0.75 (95% CI: 0.69 to 0.81) versus 0.72 (95% CI: 0.66 to 0.78) for medical judgements (p=0.28). For patients with at least one missing blood test result, the c-statistics were similar (medical judgements 0.70 (95% CI: 0.60 to 0.81) vs CARM 0.70 (95% CI: 0.59 to 0.80)). At a 10% mortality risk, the PPV for CARM was higher than medical judgements in patients with complete blood test results, 62.0% (95% CI: 51.2 to 71.9) versus 49.2% (95% CI: 39.8 to 58.5) but not when blood test results were missing, 50.0% (95% CI: 24.7 to 75.3) versus 53.3% (95% CI: 34.3 to 71.7). CONCLUSIONS: CARM is comparable with medical judgements in discriminating in-hospital mortality following emergency admission to an elderly care ward. CARM may have a promising role in supporting medical judgements in determining the patient’s risk of death in hospital. Further evaluation of CARM in routine practice is required. BMJ Publishing Group 2019-06-19 /pmc/articles/PMC6589037/ /pubmed/31221885 http://dx.doi.org/10.1136/bmjopen-2018-027741 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Health Services Research Faisal, Muhammad Khatoon, Binish Scally, Andy Richardson, Donald Irwin, Sally Davidson, Rachel Heseltine, David Corlett, Alison Ali, Javed Hampson, Rebecca Kesavan, Sandeep McGonigal, Gerry Goodman, Karen Harkness, Michael Mohammed, Mohammed A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title | A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title_full | A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title_fullStr | A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title_full_unstemmed | A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title_short | A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
title_sort | prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589037/ https://www.ncbi.nlm.nih.gov/pubmed/31221885 http://dx.doi.org/10.1136/bmjopen-2018-027741 |
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