The PEARL Score Predicts 90-Day Readmission or Death After Hospitalisation for Acute Exacerbation of COPD

In this study, researchers developed a predictive model of death without readmission and readmission in a cohort of 2,417 COPD patients hospitalized with an acute exacerbation. The final model included the following factors:

• P -- Previous admissions: history of more than two hospital admissions
• E -- eMRCD score: the extended MRC Dyspnea Scale; scores of 4 (not too dyspneic to leave the house, 5a (too dyspneic to leave the house, but independent with washing/dressing) and 5b (too dyspniec to leave the house and to wash/dress) are assigned values
• A -- Age: 80 or older
• R-- Right ventricular failure: cor pulmonale
• L -- Left ventricular failure

Patients obtain a maximum score of 9. Analysis revealed that patients could be categorized as low risk (0-1), intermediate risk (2-4) and high risk (5-9) for readmission or death within 90 days. Of note was that pneumonia, use of non-invasive ventilation or post-acute care (e.g,. long-term care facility), and previous diagnosis of anxiety or depression did not predict primary outcomes as did the PEARL variables outlined above. The authors outline the strengths and shortcomings of the study and also compare sensitive and specificity to other commonly used readmissions prediction scores.