title: The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  UKCRN ID 14214.
authors.affiliation: North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.|Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: C
authors.initials: C
authors.lastname: Echevarria
authors.affiliation: North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Steer
authors.affiliation: Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.|Royal Victoria Hospital, Newcastle upon Tyne, UK.
authors.forename: K
authors.initials: K
authors.lastname: Heslop-Marshall
authors.affiliation: Royal Victoria Hospital, Newcastle upon Tyne, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Stenton
authors.affiliation: Northern General Hospital, Sheffield, South Yorkshire, UK.
authors.forename: P M
authors.identifier: 0000-0002-4683-7696
authors.initials: PM
authors.lastname: Hickey
authors.affiliation: Northern General Hospital, Sheffield, South Yorkshire, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hughes
authors.affiliation: Royal Cornwall Hospital, Truro, Cornwall, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wijesinghe
authors.affiliation: University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK.
authors.forename: R N
authors.initials: RN
authors.lastname: Harrison
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: N
authors.initials: N
authors.lastname: Steen
authors.affiliation: Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.affiliation: Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Gibson
authors.affiliation: North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.|Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Bourke
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: COPD Exacerbations; COPD epidemiology