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    Using routine blood test results to predict the risk of death for emergency medical admissions to hospital: an external model validation study

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    Faisal_et_al_QJM.pdf (1.075Mb)
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    Publication date
    2016-08-02
    Author
    Faisal, Muhammad
    Howes, R.
    Steyerberg, E.W.
    Richardson, D.
    Mohammed, Mohammed A.
    Keyword
    Critical care; Emergency medicine; Biochemistry & metabolism
    Rights
    © The Authors 2016. Published by Oxford University Press on behalf of the Association of Physicians. This is a pre-copyedited, author-produced version of an article accepted for publication in QJM: An International Journal of Medicine following peer review. The version of record [Faisal M, Howes R, Steyerberg EW et al (2017) Using routine blood test results to predict the risk of death for emergency medical admissions to hospital: an external model validation study. QJM: An International Journal of Medicine. 110(1): 27-31.] is available online at: https://doi.org/10.1093/qjmed/hcw110
    Peer-Reviewed
    Yes
    
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    Abstract
    Background The Biochemistry and Haematology Outcome Model (BHOM) relies on the results from routine index blood tests to predict the patient risk of death. We aimed to externally validate the BHOM model. Method We considered all emergency adult medical patients who were discharged from Northern Lincolnshire and Goole (NLAG) hospital in 2014. We compared patient characteristics between NLAG (the validation sample) and the hospital where BHOM was developed. We evaluated the predictive performance, according to discriminative ability (with a concordance statistic, c), and calibration (agreement between observed and predicted risk). Result There were 29 834 emergency discharges of which 24 696 (83%) had complete data. In comparison with the development sample, the NLAG sample was similar in age, blood test results, but experienced a lower mortality (4.7% vs 8.7%). When applied to NLAG, the BHOM model had good discrimination (c-statistic 0.83 [95% CI 0.823 - 0.842]). Calibration was good overall, although the BHOM model overpredicted for lowest (<5%, observed = 229,predicted =286) and highest (≥50%, observed = 31, predicted = 49) risk groups, even after recalibrating for the differences in baseline risk of death. Conclusion Differences in patient case-mix profile and baseline risk of death need to be considered before the BHOM model can be used in another hospital. After re-calibrating for the baseline difference in risk the BHOM model had good discrimination but less adequate calibration.
    URI
    http://hdl.handle.net/10454/11623
    Version
    Accepted Manuscript
    Citation
    Faisal M, Howes R, Steyerberg EW et al (2017) Using routine blood test results to predict the risk of death for emergency medical admissions to hospital: an external model validation study. QJM: An International Journal of Medicine. 110(1): 27-31.
    Link to publisher’s version
    https://doi.org/10.1093/qjmed/hcw110
    Type
    Article
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    Health Studies Publications

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