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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

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    Faisal_et_al_BMJ_Open_2019.pdf (601.3Kb)
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    Publication date
    2019-06
    Author
    Faisal, Muhammad
    Khatoon, Binish
    Scally, Andy J.
    Richardson, D.
    Irwin, S.
    Davidson, R.
    Heseltine, D.
    Corlett, A.
    Ali, J.
    Hampson, R.
    Kesavan, S.
    McGonigal, G.
    Goodman, K.
    Harkness, M.
    Mohammed, Mohammed A.
    Show allShow less
    Keyword
    Computer-aided risk score
    Medical judgement
    Mortality
    Emergency medical admission
    Rights
    © Author(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/.
    Peer-Reviewed
    Yes
    
    Metadata
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    Abstract
    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.
    URI
    http://hdl.handle.net/10454/18015
    Version
    Published version
    Citation
    Faisal M, Khatoon B, Scally A et al (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.
    Link to publisher’s version
    http://dx.doi.org/10.1136/bmjopen-2018-027741
    Type
    Article
    Collections
    Health Studies Publications

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