The modified LACE+ score predicted 30-day urgent hospital readmission or death with adequate discrimination (c-statistic 0.681; 95% CI 0.678-0.684), performing similarly to LACE+ and LACE scores.
Cohort (n=368,154)
Yes
Do the mLACE+, LACE+, and LACE scores accurately predict urgent hospital readmission or death within 30 days of discharge in hospitalized patients?
The mLACE+, LACE+, and LACE scores demonstrate excellent calibration and adequate discrimination for predicting 30-day hospital readmission or death, supporting their use to target preventive interventions.
Effect estimate: c-statistic 0.681 (95% CI 0.678 to 0.684)
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.
Staples et al. (Sat,) conducted a cohort in Hospitalized patients (n=368,154). modified LACE+ (mLACE+) score vs. LACE+ and LACE scores was evaluated on composite of urgent hospital readmission or death within 30 days of index discharge (c-statistic 0.681, 95% CI 0.678 to 0.684). The modified LACE+ score predicted 30-day urgent hospital readmission or death with adequate discrimination (c-statistic 0.681; 95% CI 0.678-0.684), performing similarly to LACE+ and LACE scores.