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External validation of the modified LACE+, LACE+, and LACE scores to predict readmission or death after hospital discharge Staples, John; Wiksyk, Bradley; Liu, Guiping; Desai, Sameer; van Walraven, Carl; Sutherland, Jason M.

Abstract

BACKGROUND: Unplanned hospital readmissions are common adverse events. The LACE+ score has been used to identify patients at the highest risk of unplanned readmission or death, yet the external validity of this score remains uncertain. METHODS: We constructed a cohort of patients admitted to hospital between October 1, 2014 and January 31, 2017 using population-based data from British Columbia (Canada). The primary outcome was a composite of urgent hospital readmission or death within 30 days of index discharge. The primary analysis sought to optimize clinical utility and international generalizability by focusing on the modified LACE+ (mLACE+) score, a variation of the LACE+ score which excludes the Case Mix Group score. Predictive performance was assessed using model calibration and discrimination. RESULTS: Among 368,154 hospitalized individuals, 31,961 (8.7%) were urgently readmitted and 5,428 (1.5%) died within 30 days of index discharge (crude composite risk of readmission or death, 9.95%). The mLACE+ score exhibited excellent calibration (calibration-in-the-large and calibration slope no different than ideal) and adequate discrimination (c-statistic, 0.681; 95%CI, 0.678 to 0.684). Higher risk dichotomized mLACE+ scores were only modestly associated with the primary outcome (positive likelihood ratio 1.95, 95%CI 1.93 to 1.97). Predictive performance of the mLACE+ score was similar to that of the LACE+ and LACE scores. CONCLUSION: The mLACE+, LACE+ and LACE scores predict hospital readmission with excellent calibration and adequate discrimination. These scores can be used to target interventions designed to prevent unplanned hospital readmission.

Item Metadata

Title
External validation of the modified LACE+, LACE+, and LACE scores to predict readmission or death after hospital discharge
Alternate Title
External validation of LACE+ scores
Creator
Staples, John; Wiksyk, Bradley; Liu, Guiping; Desai, Sameer; van Walraven, Carl; Sutherland, Jason M.
Contributor
Centre for Clinical Epidemiology and Evaluation; Centre for Health Evaluation & Outcome Sciences; University of British Columbia. Centre for Health Services and Policy Research
Publisher
Wiley
Date Issued
2021-05-08
Description
BACKGROUND: Unplanned hospital readmissions are common adverse events. The LACE+ score has been used to identify patients at the highest risk of unplanned readmission or death, yet the external validity of this score remains uncertain. METHODS: We constructed a cohort of patients admitted to hospital between October 1, 2014 and January 31, 2017 using population-based data from British Columbia (Canada). The primary outcome was a composite of urgent hospital readmission or death within 30 days of index discharge. The primary analysis sought to optimize clinical utility and international generalizability by focusing on the modified LACE+ (mLACE+) score, a variation of the LACE+ score which excludes the Case Mix Group score. Predictive performance was assessed using model calibration and discrimination. RESULTS: Among 368,154 hospitalized individuals, 31,961 (8.7%) were urgently readmitted and 5,428 (1.5%) died within 30 days of index discharge (crude composite risk of readmission or death, 9.95%). The mLACE+ score exhibited excellent calibration (calibration-in-the-large and calibration slope no different than ideal) and adequate discrimination (c-statistic, 0.681; 95%CI, 0.678 to 0.684). Higher risk dichotomized mLACE+ scores were only modestly associated with the primary outcome (positive likelihood ratio 1.95, 95%CI 1.93 to 1.97). Predictive performance of the mLACE+ score was similar to that of the LACE+ and LACE scores. CONCLUSION: The mLACE+, LACE+ and LACE scores predict hospital readmission with excellent calibration and adequate discrimination. These scores can be used to target interventions designed to prevent unplanned hospital readmission.
Subject
patient readmission; prediction; prognosis; clinical decision rules; LACE score; LACE+ score; validation study
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2022-05-08
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0413582
URI
http://hdl.handle.net/2429/81540
Affiliation
Medicine, Faculty of; Non UBC; Medicine, Department of; Population and Public Health (SPPH), School of
Citation
Staples JA*, Wiksyk B*, Liu G, Desai S, van Walraven C, Sutherland JM (*indicates equal contribution to this work). External validation of the modified LACE+, LACE+, and LACE scores to predict readmission or death after hospital discharge. J Eval Clin Practice. 2021 Dec;27(6):1390-1397
Publisher DOI
10.1111/jep.13579
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International