External validation of the modified LACE+, LACE+, and LACE scores to predict readmission or death after hospital discharge. Issue 6 (8th May 2021)

• Record Type: Journal Article
• Authors: Staples, John A.; Wiksyk, Bradley; Liu, Guiping; Desai, Sameer; van Walraven, Carl; Sutherland, Jason M.
• Is Part Of: Journal of evaluation in clinical practice. Volume 27:Issue 6(2021)
• Page Start: 1390
• Page End: 1397
• Publication Date: 2021-05-08
• Subjects: clinical decision rules -- LACE score -- LACE+ score -- patient readmission -- prognosis -- validation study; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/jep.13579
• Languages: English
• ISSNs: 1356-1294

Abstract

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 1 October 2014 and 31 January 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 5428 (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.