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

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dc.contributor.authorFaisal, Muhammad
dc.contributor.authorKhatoon, Binish
dc.contributor.authorScally, Andy
dc.contributor.authorRichardson, Donald
dc.contributor.authorIrwin, Sally
dc.contributor.authorDavidson, Rachel
dc.contributor.authorHeseltine, David
dc.contributor.authorCorlett, Alison
dc.contributor.authorAli, Javed
dc.contributor.authorHampson, Rebecca
dc.contributor.authorKesavan, Sandeep
dc.contributor.authorMcGonigal, Gerry
dc.contributor.authorGoodman, Karen
dc.contributor.authorHarkness, Michael
dc.contributor.authorMohammed, Mohammed
dc.contributor.funderNational Institute for Health Researchen
dc.date.accessioned2019-09-10T09:12:06Z
dc.date.available2019-09-10T09:12:06Z
dc.date.issued2019-06-19
dc.description.abstractObjectives: 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.en
dc.description.sponsorshipHealth Foundation; National Institute for Health Research (NIHR) Yorkshire; Humberside Patient Safety Translational Research Centre (NIHR YHPSTRC)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide027741en
dc.identifier.citationFaisal, M., Khatoon, B., Scally, A., Richardson, D., Irwin, S., Davidson, R., Heseltine, D., Corlett, A., Ali, J., Hampson, R., Kesavan, S., McGonigal, G., Goodman, K., Harkness, M. and Mohammed, M. (2019) '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', BMJ Open, 9(6), e027741. (7pp.) DOI: 10.1136/bmjopen-2018-027741en
dc.identifier.doi10.1136/bmjopen-2018-027741en
dc.identifier.eissn2044-6055
dc.identifier.endpage7en
dc.identifier.issued6en
dc.identifier.journaltitleBMJ Openen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8500
dc.identifier.volume9en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttps://bmjopen.bmj.com/content/9/6/e027741.info
dc.rights©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/.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectAutomatic computer-aided risk of mortality (CARM)en
dc.subjectConsecutive emergency medical admissionsen
dc.subjectClinical judgementen
dc.titleA prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risken
dc.typeArticle (peer-reviewed)en
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