Predicting risk of COPD in primary care: Development and validation of a clinical risk score

Abstract

Objectives: To develop and validate a clinical risk score to identify patients at risk of chronic obstructive pulmonary disease (COPD) using clinical factors routinely recorded in primary care. Design: Case–control study of patients containing one incident COPD case to two controls matched on age, sex and general practice. Candidate risk factors were included in a conditional logistic regression model to produce a clinical score. Accuracy of the score was estimated on a separate external validation sample derived from 20 purposively selected practices. Setting: UK general practices enrolled in the Clinical Practice Research Datalink (1 January 2000 to 31 March 2006). Participants: Development sample included 340 practices containing 15 159 newly diagnosed COPD cases and 28 296 controls (mean age 70 years, 52% male). Validation sample included 2259 cases and 4196 controls (mean age 70 years, 50% male). Main outcome measures: Area under the receiver operator characteristic curve (c statistic), sensitivity and specificity in the validation practices. Results: The model included four variables including smoking status, history of asthma, and lower respiratory tract infections and prescription of salbutamol in the previous 3 years. It had a high average c statistic of 0.85 (95% CI 0.83 to 0.86) and yielded a sensitivity of 63.2% (95% CI 63.1 to 63.3) and specificity 87.4% (95% CI 87.3 to 87.5). Conclusions: Risk factors associated with COPD and routinely recorded in primary care have been used to develop and externally validate a new COPD risk score. This could be used to target patients for case finding.