{
  "abstract": "Introduction In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score.Methods This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts.Measurements and main results 241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value.Conclusions In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure.Trial registration number ISRCTN16567838.",
  "authors": [
    {
      "affiliations": [
        "University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK",
        "Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"
      ],
      "name": "Eleanor K Mishra"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, Wales, UK"
      ],
      "name": "Helen Davies"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK",
        "University of East Anglia, Norwich, UK"
      ],
      "name": "Syed Hamza Abbas"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"
      ],
      "name": "Cheryl Hardy"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK",
        "University of East Anglia, Norwich, UK"
      ],
      "name": "Dominic T Beith"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK"
      ],
      "name": "Dheeraj Sethi"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"
      ],
      "name": "Toshit Sapkal"
    },
    {
      "affiliations": [
        "Oxford Centre for Respiratory Medicine, Oxford, UK"
      ],
      "name": "Alguili Elsheikh"
    },
    {
      "affiliations": [
        "Glenfield Hospital, Leicester, UK"
      ],
      "name": "Asfandyar Yousuf"
    },
    {
      "affiliations": [
        "University of Oxford, Oxford, UK"
      ],
      "name": "Emma L Hedley"
    },
    {
      "affiliations": [
        "University of Oxford, Oxford, UK"
      ],
      "name": "Ellie Daly"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Anand Sundaralingam"
    },
    {
      "affiliations": [
        "Respiratory, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Dinesh Addala"
    },
    {
      "affiliations": [
        "Cardiff and Vale University Health Board, Cardiff, UK"
      ],
      "name": "Samantha A Jones"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Lianne Castle"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Neena Patel"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"
      ],
      "name": "Jurgen Herre"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"
      ],
      "name": "Hannah Collins"
    },
    {
      "affiliations": [
        "Hull Royal Infirmary, Hull, UK"
      ],
      "name": "Jack Kastelik"
    },
    {
      "affiliations": [
        "Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Clare L Ross"
    },
    {
      "affiliations": [
        "Interventional Pulmonology Service, Department of Respiratory Medicine, Plymouth Hospitals NHS Trust, Plymouth, UK"
      ],
      "name": "John Corcoran"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Plymouth Hospitals NHS Trust, Plymouth, UK"
      ],
      "name": "Cyrus Daneshvar"
    },
    {
      "affiliations": [
        "Arrowe Park Hospital, Upton, UK"
      ],
      "name": "Fathimath Shiham"
    },
    {
      "affiliations": [
        "Arrowe Park Hospital, Upton, UK"
      ],
      "name": "Alison Hufton"
    },
    {
      "affiliations": [
        "Southmead Hospital, Bristol, UK"
      ],
      "name": "Geraldine A Lynch"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "Alex Dipper"
    },
    {
      "affiliations": [
        "Southmead Hospital, Bristol, UK"
      ],
      "name": "Eleanor Barton"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "Amelia O Clive"
    },
    {
      "affiliations": [
        "North Bristol Lung Centre, University of Bristol, Bristol, UK"
      ],
      "name": "Nicholas A Maskell"
    },
    {
      "affiliations": [
        "Norwich Medical School, University of East Anglia, Norwich, UK"
      ],
      "name": "Allan B Clark"
    },
    {
      "affiliations": [
        "Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK"
      ],
      "name": "Najib M Rahman"
    }
  ],
  "title": "Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score",
  "uid": "5cfec497-f89a-5b2f-965b-b0db902fb0de"
}