About Computer Aided Risk Scoring Systems (CARSs)
What is CARSS?
Following a two-year study, we have developed four validated automated risk scores which we called as Computer Aided Risk Scoring Systems (CARSS).
| Computer Aided Risk Score | NEWS data only (N) | NEWS and Blood test results data (NB) |
|---|---|---|
| Mortality (M) | CARM_N | CARM_NB |
| Sepsis (S) | CARS_N | CARS_NB |
- Computer aided risk score for predicting mortality using NEWS2 data only (CARM_N)
CARM_N is a mortality risk calculator developed using age gender and physiological variable including those that make up the NEWS2 score. Under current guidelines, National Early Warning Score (NEWS2) is not used to provide an explicit estimate of the patient’s risk of death. The CARM_N score is a computer-aided NEWS model predicting the mortality risk (i.e. 0.2 = 20%, 0.8 = 80% during this hospital admission) for emergency medical admissions, so this limits the extension of our findings to non-medical and elective admissions. The CARM_N model is externally validated and are automated within the electronic record (CPD). NEWS2 is repeatedly updated for each patient according to our hospital observation protocols, and changes in NEWS over time are reflected in changes in the CARM_N mortality risk with each update.
- Computer aided risk score for predicting mortality using NEWS2 & Blood test results data (CARM_NB)
CARM_NB is a mortality risk calculator similar to CARM_N but developed using commonly requested blood results in addition to age, gender and physiological variable including those that make up the NEWS2 score. Under current guidelines, National Early Warning Score (NEWS2) is not used to provide an explicit estimate of the patient’s risk of death. The CARM_NB score is a computer-aided model predicting the mortality risk (i.e. 0.2 = 20%, 0.8 = 80% during this hospital admission) for emergency medical admissions, so this limits the extension of our findings to non-medical and elective admissions. The CARM_NB model is externally validated and are automated within the electronic record (CPD). NEWS2 is repeatedly updated for each patient according to our hospital observation protocols and blood tests may be repeated if clinically indicated and changes in NEWS and blood results over time are reflected in changes in the CARM_NB mortality risk with each update.
- Computer aided risk score for predicting sepsis using NEWS data only (CARS_N)
CARS_N is a sepsis risk calculator developed using age gender and physiological variable including those that make up the NEWS2 score. Under current guidelines, National Early Warning Score (NEWS) is not used to provide an explicit estimate of the patient’s risk of sepsis. The CARS_N score is a computer-aided NEWS model predicting the sepsis risk (i.e. 0.2 = 20%, 0.8 = 80% during this hospital admission) for emergency medical admissions, so this limits the extension of our findings to non-medical and elective admissions. The CARS_N model is externally validated and is automated within the electronic record (CPD). NEWS is repeatedly updated for each patient according to our hospital observation protocols, and changes in NEWS over time are reflected in changes in the CARS_N sepsis risk with each update.
- Computer-aided risk score for predicting sepsis using NEWS & Blood test results data (CARS_NB)
CARS_NB is a sepsis risk calculator similar to CARS_N but developed using commonly requested blood results in addition to age, gender and physiological variable including those that make up the NEWS score. Under current guidelines, National Early Warning Score (NEWS2) is not used to provide an explicit estimate of the patient’s risk of sepsis. The CARS_NB score is a computer-aided model predicting the sepsis risk (i.e. 0.2 = 20%, 0.8 = 80% during this hospital admission) for emergency medical admissions, so this limits the extension of our findings to non-medical and elective admissions. The CARS_NB model is externally validated and are automated within the electronic record (CPD). NEWS is repeatedly updated for each patient according to our hospital observation protocols and blood tests may be repeated if clinically indicated and changes in NEWS and blood results over time are reflected in changes in the CARS_NB sepsis risk with each update.
These four scores provide staff with real time estimates of the patients risk of death and sepsis during their stay in hospital.
Problem
- Decision making is complex
- Too many data items to consider
- Too many patients to consider
- Not enough time and staff
Solution
- CARSS is designed to help Doctors to identify those patients who are most at risk without any extra burden on the Doctor
- Automated risk scoring systems
- Requires no additional data
- Uses clinical variables
- Evidence based
- Subject to ongoing research and development
How is CARSS developed?
Our automated risk scores rely on two routinely collected clinical data sets – the patients vital signs data as defined by the National Early Warning Score (NEWS) and routine blood test results – and in most instances will be available within 60-minutes of unplanned admission to a ward and will be automatically updated in real-time as soon as the NEWS or blood results are updated.
NEWS is based on a range of vital signs (e.g. respiration (breathing) rate, blood pressure, heart rate, temperature) and the biomedical data is obtained from routine blood tests (e.g. albumin levels (indicate how the liver is coping), haemoglobin (cells that carry oxygen around the body), white cell count (which may indicate infection).
Why is CARSs important?
Our work has shown that staff view our automated scores favourably because the scores (a) are automated, (b) require no additional data collection and (c) combine 16 clinical variables whilst aiming to support the clinical decision-making process with real time estimates of the patient’s risk of death and sepsis.
Who is CARSs for?
The CARS algorithm is applied to patients admitted to hospital in an emergency. It is used to identify deteriorating and/or end of life stage patients.
In the former it enables earlier intervention to reduce severity of symptoms and/or co-morbidities; in the latter it facilitates timely conversations with patients and carers about the choices of care available to them.
How do I use CARSs?
For each emergency medical patient admission, a risk of mortality and/or sepsis score is reported (NEWS). The computer aided risk score (CARS) – on receipt of the NEWS score, blood test results and the variables of age and sex – can predict risk of mortality for the patient.
The CARS system is intended for use within the clinical context to predict in-hospital mortality. It is not a replacement for clinician judgement. The intention is that it used to supplement the clinical decision-making process.