Role of an Exacerbation Checklist Score (ECS) in the definition, assessment and outcome of CF pulmonary exacerbations (PEx)

Research output: Contribution to conferenceAbstract

Abstract

Objectives: A Delphi consensus of adults with CF and CF health professionals from 13 UK centres identified their most important indicators of PEx(McCourt et al. 2015). These responses were used to pilot a checklist exploring PEx signs, symptoms, severity and recovery. Methods: The highest ranked indicators populated 2 Exacerbation Checklist Scores(ECS) – one for patients(PECS) and one for clinicians(CECS). One point was given to each indicator present including ≥10% FEV1 drop, trouble breathing, reduced saturations, change in sputum, reduction in activity, CRP rise, fever, exhaustion , dyspnoea, respiratory rate, increased cough or airway clearance to maximum of 10(PECs)and 12(CECs)points. In a single centre observational study to assess response to IVs for PEx each participant and study investigator independently completed an ECS on admission. Statistics: Spearman R correlation; survival analysis. Results: 31 participants enrolled, mean(SD)age 29.8(7) yrs; mean FEV1 61.19(25)%. Mean(SD)PECS was 8.7/10(1.6) and mean CECS 7.4/12(1.8). Correlation between PECS and CECS(r=0.55,p=0.001). PECS correlated with CFRSD-CRISS score(r=0.51,p=0.003). CECS correlated with FEV1(L) on admission(r= 0.5,p=0.004) . A PECS≤9 was associated with greater FEV1 recovery at end of treatment(25%(n=5))and longer time to next IVs(90 days)(HR 0 .3)than PECS=10 where 9%(n=1) recovered FEV1 and time to next IVs was 41 days. A CECS≤8 also led to a longer time to next IVs(78 days) compared to CECS≥9(42 days)(HR 0.4). Those with lower scores were less likely to need further IVs within 30 days. A PECS cut off of ≤9(Sensitivity & Specificity 75%)has a negative predictive value(NPV)of 94% whilst a CECS ≤8(Sensitivity 50%, specificity 76%)has a NPV of 91% for no further IVs within 30 days. Conclusion: A simple ECS may be useful to determine PEx severity, correlate with clinical parameters and assist in clinical course prediction. Further validation of the ECS is warranted in a larger population.
Original languageEnglish
Publication statusAccepted - 2018
EventEuropean Cystic Fibrosis Society Conference, 2018 - Belgrade, Serbia
Duration: 06 Jun 2018 → …
https://www.ecfs.eu/belgrade2018

Conference

ConferenceEuropean Cystic Fibrosis Society Conference, 2018
Abbreviated titleECFS
CountrySerbia
CityBelgrade
Period06/06/2018 → …
Internet address

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Checklist
Outcome Assessment (Health Care)
Lung
Survival Analysis
Respiratory Rate
Sputum
Cough
Dyspnea
Signs and Symptoms
Observational Studies
Respiration
Fever
Research Personnel
Sensitivity and Specificity
Health
Population
Therapeutics

Cite this

Addy, C., Bradley, J., Elborn, J., Bradbury, I., & Downey, D. (Accepted/In press). Role of an Exacerbation Checklist Score (ECS) in the definition, assessment and outcome of CF pulmonary exacerbations (PEx). Abstract from European Cystic Fibrosis Society Conference, 2018, Belgrade, Serbia.
@conference{436a97a219df418383fcd972f9610390,
title = "Role of an Exacerbation Checklist Score (ECS) in the definition, assessment and outcome of CF pulmonary exacerbations (PEx)",
abstract = "Objectives: A Delphi consensus of adults with CF and CF health professionals from 13 UK centres identified their most important indicators of PEx(McCourt et al. 2015). These responses were used to pilot a checklist exploring PEx signs, symptoms, severity and recovery. Methods: The highest ranked indicators populated 2 Exacerbation Checklist Scores(ECS) – one for patients(PECS) and one for clinicians(CECS). One point was given to each indicator present including ≥10{\%} FEV1 drop, trouble breathing, reduced saturations, change in sputum, reduction in activity, CRP rise, fever, exhaustion , dyspnoea, respiratory rate, increased cough or airway clearance to maximum of 10(PECs)and 12(CECs)points. In a single centre observational study to assess response to IVs for PEx each participant and study investigator independently completed an ECS on admission. Statistics: Spearman R correlation; survival analysis. Results: 31 participants enrolled, mean(SD)age 29.8(7) yrs; mean FEV1 61.19(25){\%}. Mean(SD)PECS was 8.7/10(1.6) and mean CECS 7.4/12(1.8). Correlation between PECS and CECS(r=0.55,p=0.001). PECS correlated with CFRSD-CRISS score(r=0.51,p=0.003). CECS correlated with FEV1(L) on admission(r= 0.5,p=0.004) . A PECS≤9 was associated with greater FEV1 recovery at end of treatment(25{\%}(n=5))and longer time to next IVs(90 days)(HR 0 .3)than PECS=10 where 9{\%}(n=1) recovered FEV1 and time to next IVs was 41 days. A CECS≤8 also led to a longer time to next IVs(78 days) compared to CECS≥9(42 days)(HR 0.4). Those with lower scores were less likely to need further IVs within 30 days. A PECS cut off of ≤9(Sensitivity & Specificity 75{\%})has a negative predictive value(NPV)of 94{\%} whilst a CECS ≤8(Sensitivity 50{\%}, specificity 76{\%})has a NPV of 91{\%} for no further IVs within 30 days. Conclusion: A simple ECS may be useful to determine PEx severity, correlate with clinical parameters and assist in clinical course prediction. Further validation of the ECS is warranted in a larger population.",
author = "Charlotte Addy and Judy Bradley and Joseph Elborn and Ian Bradbury and Damian Downey",
year = "2018",
language = "English",
note = "European Cystic Fibrosis Society Conference, 2018, ECFS ; Conference date: 06-06-2018",
url = "https://www.ecfs.eu/belgrade2018",

}

Role of an Exacerbation Checklist Score (ECS) in the definition, assessment and outcome of CF pulmonary exacerbations (PEx). / Addy, Charlotte; Bradley, Judy; Elborn, Joseph; Bradbury, Ian; Downey, Damian.

2018. Abstract from European Cystic Fibrosis Society Conference, 2018, Belgrade, Serbia.

Research output: Contribution to conferenceAbstract

TY - CONF

T1 - Role of an Exacerbation Checklist Score (ECS) in the definition, assessment and outcome of CF pulmonary exacerbations (PEx)

AU - Addy, Charlotte

AU - Bradley, Judy

AU - Elborn, Joseph

AU - Bradbury, Ian

AU - Downey, Damian

PY - 2018

Y1 - 2018

N2 - Objectives: A Delphi consensus of adults with CF and CF health professionals from 13 UK centres identified their most important indicators of PEx(McCourt et al. 2015). These responses were used to pilot a checklist exploring PEx signs, symptoms, severity and recovery. Methods: The highest ranked indicators populated 2 Exacerbation Checklist Scores(ECS) – one for patients(PECS) and one for clinicians(CECS). One point was given to each indicator present including ≥10% FEV1 drop, trouble breathing, reduced saturations, change in sputum, reduction in activity, CRP rise, fever, exhaustion , dyspnoea, respiratory rate, increased cough or airway clearance to maximum of 10(PECs)and 12(CECs)points. In a single centre observational study to assess response to IVs for PEx each participant and study investigator independently completed an ECS on admission. Statistics: Spearman R correlation; survival analysis. Results: 31 participants enrolled, mean(SD)age 29.8(7) yrs; mean FEV1 61.19(25)%. Mean(SD)PECS was 8.7/10(1.6) and mean CECS 7.4/12(1.8). Correlation between PECS and CECS(r=0.55,p=0.001). PECS correlated with CFRSD-CRISS score(r=0.51,p=0.003). CECS correlated with FEV1(L) on admission(r= 0.5,p=0.004) . A PECS≤9 was associated with greater FEV1 recovery at end of treatment(25%(n=5))and longer time to next IVs(90 days)(HR 0 .3)than PECS=10 where 9%(n=1) recovered FEV1 and time to next IVs was 41 days. A CECS≤8 also led to a longer time to next IVs(78 days) compared to CECS≥9(42 days)(HR 0.4). Those with lower scores were less likely to need further IVs within 30 days. A PECS cut off of ≤9(Sensitivity & Specificity 75%)has a negative predictive value(NPV)of 94% whilst a CECS ≤8(Sensitivity 50%, specificity 76%)has a NPV of 91% for no further IVs within 30 days. Conclusion: A simple ECS may be useful to determine PEx severity, correlate with clinical parameters and assist in clinical course prediction. Further validation of the ECS is warranted in a larger population.

AB - Objectives: A Delphi consensus of adults with CF and CF health professionals from 13 UK centres identified their most important indicators of PEx(McCourt et al. 2015). These responses were used to pilot a checklist exploring PEx signs, symptoms, severity and recovery. Methods: The highest ranked indicators populated 2 Exacerbation Checklist Scores(ECS) – one for patients(PECS) and one for clinicians(CECS). One point was given to each indicator present including ≥10% FEV1 drop, trouble breathing, reduced saturations, change in sputum, reduction in activity, CRP rise, fever, exhaustion , dyspnoea, respiratory rate, increased cough or airway clearance to maximum of 10(PECs)and 12(CECs)points. In a single centre observational study to assess response to IVs for PEx each participant and study investigator independently completed an ECS on admission. Statistics: Spearman R correlation; survival analysis. Results: 31 participants enrolled, mean(SD)age 29.8(7) yrs; mean FEV1 61.19(25)%. Mean(SD)PECS was 8.7/10(1.6) and mean CECS 7.4/12(1.8). Correlation between PECS and CECS(r=0.55,p=0.001). PECS correlated with CFRSD-CRISS score(r=0.51,p=0.003). CECS correlated with FEV1(L) on admission(r= 0.5,p=0.004) . A PECS≤9 was associated with greater FEV1 recovery at end of treatment(25%(n=5))and longer time to next IVs(90 days)(HR 0 .3)than PECS=10 where 9%(n=1) recovered FEV1 and time to next IVs was 41 days. A CECS≤8 also led to a longer time to next IVs(78 days) compared to CECS≥9(42 days)(HR 0.4). Those with lower scores were less likely to need further IVs within 30 days. A PECS cut off of ≤9(Sensitivity & Specificity 75%)has a negative predictive value(NPV)of 94% whilst a CECS ≤8(Sensitivity 50%, specificity 76%)has a NPV of 91% for no further IVs within 30 days. Conclusion: A simple ECS may be useful to determine PEx severity, correlate with clinical parameters and assist in clinical course prediction. Further validation of the ECS is warranted in a larger population.

M3 - Abstract

ER -