TY - JOUR T1 - Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis JF - Br J Gen Pract Y1 - 2010 A1 - McNally, Maggie A1 - Curtain, James A1 - O'Brien, K A1 - Dimitrov, B A1 - Fahey, T KW - Family Practice KW - Great Britain KW - Humans KW - Pneumonia KW - Prognosis KW - Risk Assessment KW - Severity of Illness Index KW - Validation Studies as Topic AB - BACKGROUND: The CRB-65 score is a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality. AIM: The study sought to validate CRB-65 and assess its clinical value in community and hospital settings. DESIGN OF STUDY: Systematic review and meta-analysis of validation studies of CRB-65. METHOD: Medline (1966 to June 2009), Embase (1988 to November 2008), British Nursing Index (BNI) and PsychINFO were searched, using a diagnostic accuracy search filter combined with subject-specific terms. The derived (index) rule was used as a predictive model and applied to all validation studies. Comparison was made between the observed and predicted number of deaths stratified by risk group (low, intermediate, and high) and setting of care (community or hospital). Pooled results are presented as risk ratios (RRs) in terms of over-prediction (RR>1) or under-prediction (RR<1) of 30-day mortality. RESULTS: Fourteen validation studies totalling 397 875 patients are included. CRB-65 performs well in hospitalised patients, particularly in those classified as intermediate (RR 0.91, 95% confidence interval [CI] = 0.71 to 1.17) or high risk (RR 1.01, 95% CI = 0.87 to 1.16). In community settings, CRB-65 over-predicts the probability of 30-day mortality across all strata of predicted risk, low (RR 9.41, 95% CI = 1.75 to 50.66), intermediate (RR 4.84, 95% CI = 2.61 to 8.69), and high (RR 1.58, 95% CI = 0.59 to 4.19). CONCLUSION: CRB-65 performs well in stratifying severity of pneumonia and resultant 30-day mortality in hospital settings. In community settings, CRB-65 appears to over-predict the probability of 30-day mortality across all strata of predicted risk. Caution is needed when applying CRB-65 to patients in general practice. VL - 60 UR - http://bjgp.org/content/60/579/e423 IS - 579 ER - TY - JOUR T1 - A systematic review of the probability of repeated admission score in community-dwelling adults JF - J Am Geriatr Soc Y1 - 2013 A1 - Wallace, E A1 - Hinchey, T A1 - Dimitrov, B A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - Aged KW - Aged, 80 and over KW - Brazil KW - Calibration KW - Decision Support Techniques KW - Europe KW - Female KW - Health Care Costs KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Patient Readmission KW - Probability KW - Reproducibility of Results KW - Risk Assessment KW - Sensitivity and Specificity KW - United States KW - Validation Studies as Topic AB - OBJECTIVES: To perform a systematic review of the Probability of Repeated Admission (Pra) score in community-dwelling adults to assess its performance in a range of validation studies in the community setting. DESIGN: Systematic review and meta-analysis. SETTING: Primary and community care. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The primary outcome was hospital admission; secondary outcomes were mortality, hospital days, functional decline, other health service use, and costs. RESULTS: Nine validation studies describing 11 cohorts of individuals aged 65 and older were identified. A metaanalysis of the Pra score in five cohorts (8,843 individuals) with comparable and available data revealed good discrimination performance (summary area under the receiver operating characteristic curve 69.7% (standard error 2.8%)). Pooled specificity was high (96%, 95% confidence interval (CI)=95.8–96.7%), indicating that a Pra score of 0.5 or greater effectively rules in the likelihood of admission, but pooled sensitivity was low (12%, 95% CI=10.5–13.6%). Calibration performance was good, with an overall risk ratio of 1.12 (95% CI=0.89–1.42), indicating that the Pra score reliably predicted hospital admissions. CONCLUSION: The Pra score performs well in predicting hospital admission in community-dwelling adults categorized as high risk according to the score. This tool has clinical and healthcare policy utility in terms of targeting elderly people at highest risk of hospital admission, but the low pooled sensitivity of the score indicates that it is not a reliable way of excluding hospital admission in those stratified as low risk. VL - 61 UR - http://onlinelibrary.wiley.com/doi/10.1111/jgs.12150/abstract IS - 3 ER - TY - JOUR T1 - Prognostic value of the ABCD² clinical prediction rule: a systematic review and meta-analysis JF - Fam Pract Y1 - 2011 A1 - Galvin, R A1 - Geraghty, Colm A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T KW - Humans KW - Ischemic Attack, Transient KW - Predictive Value of Tests KW - Risk Assessment KW - Risk Factors KW - Stroke KW - Time Factors AB - OBJECTIVE: The purpose of this systematic review with meta-analysis is to determine the predictive value of the ABCD ²at 7 and 90 days across three strata of risk. Background. The risk of stroke after transient ischaemic attack (TIA) is significant. The ABCD ²clinical prediction rule is designed to predict early risk of stroke after TIA. A number of independent validation studies have been conducted since the rule was derived. METHODS: A systematic literature search was conducted to identify studies that validated the ABCD². The derived rule was used as a predictive model and applied to subsequent validation studies. Comparisons were made between observed and predicted number of strokes stratified by risk group: low (0-3 points), moderate (4-5 points) and high (6-7 points). Pooled results are presented as risk ratios (RRs) with 95% confidence intervals (CIs), in terms of over-prediction (RR > 1) or under-prediction (RR < 1) of stroke at 7 and 90 days. RESULTS: We include 16 validation studies. Fourteen studies report 7-day stroke risk (n = 6282, 388 strokes). The ABCD² rule correctly predicts occurrence of stroke at 7 days across all three risk strata: low [RR 0.86, 95% CI (0.47-1.58), I² = 16%], moderate [RR 0.99, 95% CI (0.67-1.47), I² = 68%] and high [RR 0.84, 95% CI (0.6-1.19), I² = 46%]. Eleven studies report 90-day stroke risk (n = 6304). There is a non-significant trend towards over-prediction of stroke in all risk categories at 90 days. There are 426 strokes observed in contrast to a predicted 626 strokes. As the trichotomized ABCD² score increases, the risk of stroke increases (P < 0.01). There is no evidence of publication bias in these studies (P > 0.05). CONCLUSION: The ABCD² is a useful CPR, particularly in relation to 7-day risk of stroke. VL - 28 UR - http://fampra.oxfordjournals.org/content/28/4/366 IS - 4 ER -