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Chronic obstructive pulmonary disease
Original article
The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD
  1. C Echevarria1,2,
  2. J Steer1,
  3. K Heslop-Marshall2,3,
  4. S C Stenton3,
  5. P M Hickey4,
  6. R Hughes4,
  7. M Wijesinghe5,
  8. R N Harrison6,
  9. N Steen7,
  10. A J Simpson2,
  11. G J Gibson2,
  12. S C Bourke1,2
  1. 1 North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK
  2. 2 Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Royal Victoria Hospital, Newcastle upon Tyne, UK
  4. 4 Northern General Hospital, Sheffield, South Yorkshire, UK
  5. 5 Royal Cornwall Hospital, Truro, Cornwall, UK
  6. 6 University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
  7. 7 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr SC Bourke, North Tyneside General Hospital, Rake Lane, North Shields, Newcastle upon Tyne NE29 8NH, UK; Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; Stephen.Bourke{at}nhct.nhs.uk

Abstract

Background One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement.

Methods In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores.

Results Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission.

Conclusions The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population.

Trial registration number UKCRN ID 14214.

  • COPD Exacerbations
  • COPD epidemiology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/thoraxjnl-2016-209298

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    Footnotes

    • Contributors SCB designed and obtained funding for the study. CE, GJG and JS contributed to trial design. SCB, MW, RNH, RH and SCS were primary investigators at each site. CE collated the data, performed the statistical analysis and drafted the manuscript. Data analysis and interpretation was supported by SCB, GJG, JS and NS. The manuscript was redrafted by SCB, GJG, JS and CE. All authors were involved with data acquisition, contributed to the interpretation of results and reviewed and approved the final manuscript.

    • Funding This trial was funded by the Department of Health, Breathe North appeal and Novartis Pharmaceuticals UK, and supported by the NIHR Clinical Research Network. The salary of CE was funded by the Northumbria NHS Foundation Trust Teaching and Research Fellowship programme.

    • Competing interests None declared.

    • Ethics approval The study was approved by NRES Committee North East, UK (REC reference: 12/NE/0379).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Any individuals or parties interested in accessing out data should contact SCB.

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