A Computer Application to Predict Adverse Events in the Short-Term Evolution of Patients With Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic disease. Exacerbations of COPD (eCOPD) contribute to the worsening of the disease and the patient's evolution. There are some clinical prediction rules that may help to stratify patients with eCOPD by their risk of poor evolution or adverse events. The translation of these clinical prediction rules into computer applications would allow their implementation in clinical practice.

Objective: The goal of this study was to create a computer application to predict various outcomes related to adverse events of short-term evolution in eCOPD patients attending an emergency department (ED) based on valid and reliable clinical prediction rules.

Methods: A computer application, Prediction of Evolution of patients with eCOPD (PrEveCOPD), was created to predict 2 outcomes related to adverse events: (1) mortality during hospital admission or within a week after an ED visit and (2) admission to an intensive care unit (ICU) or an intermediate respiratory care unit (IRCU) during the eCOPD episode. The algorithms included in the computer tool were based on clinical prediction rules previously developed and validated within the Investigación en Resultados y Servicios de Salud COPD study. The app was developed for Windows and Android systems, using Visual Studio 2008 and Eclipse, respectively.

Results: The PrEveCOPD computer application implements the prediction models previously developed and validated for 2 relevant adverse events in the short-term evolution of patients with eCOPD. The application runs under Windows and Android systems and it can be used locally or remotely as a Web application. Full description of the clinical prediction rules as well as the original references is included on the screen. Input of the predictive variables is controlled for out-of-range and missing values. Language can be switched between English and Spanish. The application is available for downloading and installing on a computer, as a mobile app, or to be used remotely via internet.

Conclusions: The PrEveCOPD app shows how clinical prediction rules can be summarized into simple and easy to use tools, which allow for the estimation of the risk of short-term mortality and ICU or IRCU admission for patients with eCOPD. The app can be used on any computer device, including mobile phones or tablets, and it can guide the clinicians to a valid stratification of patients attending the ED with eCOPD.

Trial registration: ClinicalTrials.gov NCT00102401; https://ichgcp.net/clinical-trials-registry/NCT02434536 (Archived by WebCite at http://www.webcitation.org/76iwTxYuA).

International registered report identifier (irrid): RR2-10.1186/1472-6963-11-322.

Keywords: COPD; clinical prediction rule; disease exacerbation; intensive care; mobile app; mortality.

Conflict of interest statement

Conflicts of Interest: None declared.

©Inmaculada Arostegui, María José Legarreta, Irantzu Barrio, Cristobal Esteban, Susana Garcia-Gutierrez, Urko Aguirre, José María Quintana, IRYSS-COPD Group. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 17.04.2019.

Figures

Figure 1

Summary of the process for the 2 outcomes (death and intensive care unit or intermediate respiratory care unit admission): score development and stratification into risk categories. ED: emergency department; ICU: intensive care unit; IRCU: intermediate respiratory care unit; LTHOT: long-term home oxygen therapy; MRC: Medical Research Council; NIMV: noninvasive mechanical ventilation; PCO2: pressure of carbon dioxide.

Figure 2

Screenshot of the application running under the Android platform. Data for an imaginary subject with complete information displayed as an example. ED: emergency department; ICU: intensive care unit; IRCU: intermediate respiratory care unit; LTHOT: long-term home oxygen therapy; MRC: Medical Research Council; NIMV: noninvasive mechanical ventilation; PCO2: pressure of carbon dioxide.

Figure 3

Screenshot of the application running under Windows and Web platforms. Data for an imaginary subject with incomplete information displayed as an example. ED: emergency department; ICU: intensive care unit; IRCU: intermediate respiratory care unit; LTHOT: long-term home oxygen therapy; MRC: Medical Research Council; NIMV: noninvasive mechanical ventilation; PCO2: pressure of carbon dioxide.