The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD

Abstract

BackgroundOne 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.MethodsIn 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.ResultsOf 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.ConclusionsThe 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 numberUKCRN ID 14214.

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

“…159 This outcome is dependent on the severity of patients included and can be predicted utilising tools such as the PEARL score. 109 Our analysis suggests that the overall readmission rates were similar to those predicted by the PEARL score and are representative of the wider COPD population.…”

“…109 Post hoc analysis compared the rates of exacerbation and hospital readmission with those predicted by the PEARL score for patients who completed the study or, when possible to ascertain, who had an event prior to withdrawal.…”

“…During the trial a new predictive measure for readmission was developed 109 and we used the trial data to see if there was a relationship between the participants' PEARL prediction score and readmission.…”

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“…In Thorax , Echevarria and colleagues describe the development of a new prognostic tool for use in patients admitted with an AECOPD 3. The initial derivation and subsequent validation cohorts, including six UK centres, were those that were also used in the development of the Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation (DECAF) score, a tool to identify patients who can be safely discharged 4 5.…”