{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:48:39Z","timestamp":1792687719152,"version":"4.5.0"},"reference-count":38,"publisher":"Royal College of General Practitioners","issue":"713","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There is no published algorithm predicting asthma crisis events (accident and emergency [A&amp;E] attendance, hospitalisation, or death) using routinely available electronic health record (EHR) data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To develop an algorithm to identify individuals at high risk of an asthma crisis event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Database analysis from primary care EHRs of people with asthma across England and Scotland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Multivariable logistic regression was applied to a dataset of 61 861 people with asthma from England and Scotland using the Clinical Practice Research Datalink. External validation was performed using the Secure Anonymised Information Linkage Databank of 174 240 patients from Wales. Outcomes were \u22651 hospitalisation (development dataset) and asthma-related hospitalisation, A&amp;E attendance, or death (validation dataset) within a 12-month period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Risk factors for asthma-related crisis events included previous hospitalisation, older age, underweight, smoking, and blood eosinophilia. The prediction algorithm had acceptable predictive ability with a receiver operating characteristic of 0.71 (95% confidence interval [CI] = 0.70 to 0.72) in the validation dataset. Using a cut-point based on the 7% of the population at greatest risk results in a positive predictive value of 5.7% (95% CI = 5.3% to 6.1%) and a negative predictive value of 98.9% (95% CI = 98.9% to 99.0%), with sensitivity of 28.5% (95% CI = 26.7% to 30.3%) and specificity of 93.3% (95% CI = 93.2% to 93.4%); those individuals had an event risk of 6.0% compared with 1.1% for the remaining population. In total, 18 people would need to be followed to identify one admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This externally validated algorithm has acceptable predictive ability for identifying patients at high risk of asthma-related crisis events and excluding those not at high risk.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2020.1042","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T16:50:12Z","timestamp":1623775812000},"page":"e948-e957","source":"Crossref","is-referenced-by-count":21,"title":["Predicting asthma-related crisis events using routine electronic healthcare data: a quantitative database analysis study"],"prefix":"10.3399","volume":"71","author":[{"given":"Michael","family":"Noble","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Burden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Stirling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan B","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Musgrave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad A","family":"Alsallakh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwyneth A","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Pinnock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Pond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Sheikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika J","family":"Sims","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"2021112517301934000_71.713.e948.1","unstructured":"British Thoracic Society and Scottish Intercollegiate Guidelines Network (2019) British guideline on the management of asthma: a national clinical guideline, https:\/\/www.brit-thoracic.org.uk\/quality-improvement\/guidelines\/asthma (accessed 8 Oct 2021)."},{"key":"2021112517301934000_71.713.e948.2","unstructured":"NHS England Report of the Review of the Quality and Outcomes Framework in England, https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2018\/07\/quality-outcome-framework-report-of-the-review.pdf (accessed 8 Oct 2021)."},{"key":"2021112517301934000_71.713.e948.3","unstructured":"Asthma UK (2021) Asthma facts and statistics. https:\/\/www.asthma.org.uk\/about\/media\/facts-and-statistics (accessed 17 Sep 2021)."},{"key":"2021112517301934000_71.713.e948.4","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-016-0657-8"},{"issue":"1","key":"2021112517301934000_71.713.e948.5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.anai.2015.10.014","article-title":"Developing a risk stratification model for predicting future health care use in asthmatic children","volume":"116","author":"Hanson","year":"2016","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2021112517301934000_71.713.e948.6","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.165.2.2102127"},{"key":"2021112517301934000_71.713.e948.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.2008.03157.x"},{"key":"2021112517301934000_71.713.e948.8","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-210939"},{"key":"2021112517301934000_71.713.e948.9","unstructured":"Asthma UK Asthma attack risk checker. https:\/\/www.asthma.org.uk\/advice\/manage-your-asthma\/risk (accessed 8 Oct 2021)."},{"key":"2021112517301934000_71.713.e948.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.08.015"},{"key":"2021112517301934000_71.713.e948.11","first-page":"A2248","article-title":"A simple asthma severity score predicts exacerbations","volume":"183","author":"Blakey","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2021112517301934000_71.713.e948.12","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2020.1841224."},{"key":"2021112517301934000_71.713.e948.13","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202093"},{"key":"2021112517301934000_71.713.e948.14","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200801-060ST"},{"issue":"11","key":"2021112517301934000_71.713.e948.15","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S2213-2600(15)00367-7","article-title":"Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study","volume":"3","author":"Price","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2021112517301934000_71.713.e948.16","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2021112517301934000_71.713.e948.17","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-9-3"},{"key":"2021112517301934000_71.713.e948.18","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-157"},{"key":"2021112517301934000_71.713.e948.19","unstructured":"(2003) New GMS Contract 2003: investing in general practice (BMA, London) NHS Confederation, British Medical Association,."},{"key":"2021112517301934000_71.713.e948.20","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.4.266"},{"key":"2021112517301934000_71.713.e948.21","first-page":"CD007524","article-title":"Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children","volume":"10","author":"Quon","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"2021112517301934000_71.713.e948.22","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/S2213-2600(17)30306-5","article-title":"Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data","volume":"5","author":"Jolliffe","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2021112517301934000_71.713.e948.23","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1403291"},{"issue":"1","key":"2021112517301934000_71.713.e948.24","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12939-020-01160-0","article-title":"Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions: a systematic review of peer-reviewed literature, 1990\u20132018","volume":"19","author":"Wallar","year":"2020","journal-title":"Int J Equity Health"},{"key":"2021112517301934000_71.713.e948.25","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3180329368"},{"key":"2021112517301934000_71.713.e948.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7187.843"},{"key":"2021112517301934000_71.713.e948.27","unstructured":"Royal College of Physicians (2015) National review of asthma deaths, https:\/\/www.rcplondon.ac.uk\/projects\/national-review-asthma-deaths (accessed 8 Oct 2021)."},{"issue":"4","key":"2021112517301934000_71.713.e948.28","first-page":"e91","article-title":"Long-acting \u00df-agonist monotherapy among children and adults with asthma","volume":"17","author":"Wasilevich","year":"2011","journal-title":"Am J Manag Care"},{"issue":"4","key":"2021112517301934000_71.713.e948.29","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.jaip.2016.11.007","article-title":"Identifying risk of future asthma attacks using uk medical record data: a Respiratory Effectiveness Group initiative","volume":"5","author":"Blakey","year":"2017","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2021112517301934000_71.713.e948.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39609.449676.25"},{"key":"2021112517301934000_71.713.e948.31","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000171"},{"key":"2021112517301934000_71.713.e948.32","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1368-8"},{"key":"2021112517301934000_71.713.e948.33","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01872-2019"},{"issue":"1","key":"2021112517301934000_71.713.e948.34","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/s41533-018-0096-4","article-title":"\u201cTossing a coin:\u201d defining the excessive use of short-acting beta2-agonists in asthma \u2014 the views of general practitioners and asthma experts in primary and secondary care\u201d","volume":"28","author":"McKibben","year":"2018","journal-title":"NPJ Prim Care Respir Med"},{"issue":"410","key":"2021112517301934000_71.713.e948.35","first-page":"529","article-title":"A confidential enquiry into deaths caused by asthma in an English health region: implications for general practice","volume":"46","author":"Mohan","year":"1996","journal-title":"Br J Gen Pract"},{"key":"2021112517301934000_71.713.e948.36","unstructured":"NHS England, British Medical Association (2020) 2020\/21 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF): guidance for GMS contract 2020\/21 in England, https:\/\/www.england.nhs.uk\/coronavirus\/wp-content\/uploads\/sites\/52\/2020\/03\/C0713-202021-General-Medical-Services-GMS-contract-Quality-and-Outcomes-Framework-QOF-Guidance.pdf (accessed 8 Oct 2021)."},{"key":"2021112517301934000_71.713.e948.37","unstructured":"Pearson MG Bucknall CE (1999) Measuring clinical outcome in asthma: a patient-focused approach (Royal College of Physicians, London)."},{"issue":"1","key":"2021112517301934000_71.713.e948.38","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1186\/s13063-018-2816-z","article-title":"At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations","volume":"19","author":"Smith","year":"2018","journal-title":"Trials"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2020.1042","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:20:10Z","timestamp":1645816810000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2020.1042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,15]]},"references-count":38,"journal-issue":{"issue":"713","published-online":{"date-parts":[[2021,11,25]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.3399\/BJGP.2020.1042"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2020.1042","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,15]]}}}