PEARL score for COPD exacerbations


TITLE: PEARL score predicts COPD readmissions

CLINICAL QUESTION: Which prognostic score is best at predicting 90-day readmission and mortality for patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?

BACKGROUND: One-third of patients hospitalized for AECOPD are readmitted within 90 days. Previous prognostic tools (ADO, BODEX, CODEX and DOSE) have been developed, but remain suboptimal.

STUDY DESIGN: Prospective study with three separate cohorts: derivation, internal validation, and external validation.

SETTING: Six hospitals in the United Kingdom.

SYNOPSIS: 2,417 patients were included and 936 were readmitted or died within 90 days of index admission. Patients with expected survival for less than 1 year for reasons other than COPD were excluded. The indices retained in the final PEARL score were: Previous admissions for AECOPD of 2 or more (2 points), extended medical research council (MRC) dyspnea score of 4, 5a or 5b (1, 2, or 3 points), age of 80 or older (1 point), clinical diagnoses of right-sided heart failure (1 point) and/or left-sided heart failure on echocardiogram (1 point). Higher scores were associated with a shorter time to death or readmission. The performance of PEARL was superior to all alternative scoring systems. The major limitation to this study is that it did not differentiate between respiratory and other causes of readmission.

BOTTOM LINE: The PEARL score can be calculated for patients hospitalized for AECOPD to predict their 90-day readmission rate and/or mortality risk.

CITATION: Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, et al. The PEARL score predicts 90-day readmission or death after hospitalization for acute exacerbation of COPD. Thorax. 2017; doi: 10.1136/thoraxjnl-2016-209298.

Dr. Ayoubieh is assistant professor in the division of hospital medicine at the University of New Mexico.

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