Use of a risk nomogram to predict emergency department reattendance in older people after discharge: a validation study

Glenn Arendts, Christopher Etherton-Beer, R. Jones, K. Bullow, E. Macdonald, S. Dumas, D. Parker, M. Hutton, S. Burrows, Simon Brown, Osvaldo Almeida

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    Abstract

    © 2015, SIMI. In older people, revisit to the emergency department (ED) in the short period after discharge is not entirely avoidable, but in a proportion of cases is preventable, and should ideally be minimised. We have previously derived a risk probability nomogram to predict the likelihood of revisit. In this study, we sought to validate the nomogram for use as a general risk stratification tool for use in older people being discharged from ED. We conducted a prospective cohort study, applying the nomogram to consecutive community dwelling discharged patients aged 65 and over. Patients were followed up at 28 days post-discharge to determine whether there had been any unplanned ED revisit in that period. We cross tabulated predicted risk versus revisit rates. In 1143 study subjects, we find the odds of revisit increases progressively with increasing strata of predicted risk, culminating in an OR of 9.7 (95 % CI 4.7–19.9) in the highest risk group. The 28-day revisit rates across strata range from 16 % through 65 %, with the difference between strata being statistically highly significant (p <0.001). The area under the ROC curve is 0.65. We conclude that the risk nomogram can classify older people discharged from ED into risk strata, and has modest overall predictive value.
    Original languageEnglish
    Pages (from-to)481-487
    JournalINTERNAL AND EMERGENCY MEDICINE
    Volume10
    Issue number4
    DOIs
    Publication statusPublished - 2015

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    Nomograms
    Validation Studies
    Hospital Emergency Service
    Independent Living
    ROC Curve
    Area Under Curve
    Cohort Studies
    Prospective Studies

    Cite this

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    title = "Use of a risk nomogram to predict emergency department reattendance in older people after discharge: a validation study",
    abstract = "{\circledC} 2015, SIMI. In older people, revisit to the emergency department (ED) in the short period after discharge is not entirely avoidable, but in a proportion of cases is preventable, and should ideally be minimised. We have previously derived a risk probability nomogram to predict the likelihood of revisit. In this study, we sought to validate the nomogram for use as a general risk stratification tool for use in older people being discharged from ED. We conducted a prospective cohort study, applying the nomogram to consecutive community dwelling discharged patients aged 65 and over. Patients were followed up at 28 days post-discharge to determine whether there had been any unplanned ED revisit in that period. We cross tabulated predicted risk versus revisit rates. In 1143 study subjects, we find the odds of revisit increases progressively with increasing strata of predicted risk, culminating in an OR of 9.7 (95 {\%} CI 4.7–19.9) in the highest risk group. The 28-day revisit rates across strata range from 16 {\%} through 65 {\%}, with the difference between strata being statistically highly significant (p <0.001). The area under the ROC curve is 0.65. We conclude that the risk nomogram can classify older people discharged from ED into risk strata, and has modest overall predictive value.",
    author = "Glenn Arendts and Christopher Etherton-Beer and R. Jones and K. Bullow and E. Macdonald and S. Dumas and D. Parker and M. Hutton and S. Burrows and Simon Brown and Osvaldo Almeida",
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    Use of a risk nomogram to predict emergency department reattendance in older people after discharge: a validation study. / Arendts, Glenn; Etherton-Beer, Christopher; Jones, R.; Bullow, K.; Macdonald, E.; Dumas, S.; Parker, D.; Hutton, M.; Burrows, S.; Brown, Simon; Almeida, Osvaldo.

    In: INTERNAL AND EMERGENCY MEDICINE, Vol. 10, No. 4, 2015, p. 481-487.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Use of a risk nomogram to predict emergency department reattendance in older people after discharge: a validation study

    AU - Arendts, Glenn

    AU - Etherton-Beer, Christopher

    AU - Jones, R.

    AU - Bullow, K.

    AU - Macdonald, E.

    AU - Dumas, S.

    AU - Parker, D.

    AU - Hutton, M.

    AU - Burrows, S.

    AU - Brown, Simon

    AU - Almeida, Osvaldo

    PY - 2015

    Y1 - 2015

    N2 - © 2015, SIMI. In older people, revisit to the emergency department (ED) in the short period after discharge is not entirely avoidable, but in a proportion of cases is preventable, and should ideally be minimised. We have previously derived a risk probability nomogram to predict the likelihood of revisit. In this study, we sought to validate the nomogram for use as a general risk stratification tool for use in older people being discharged from ED. We conducted a prospective cohort study, applying the nomogram to consecutive community dwelling discharged patients aged 65 and over. Patients were followed up at 28 days post-discharge to determine whether there had been any unplanned ED revisit in that period. We cross tabulated predicted risk versus revisit rates. In 1143 study subjects, we find the odds of revisit increases progressively with increasing strata of predicted risk, culminating in an OR of 9.7 (95 % CI 4.7–19.9) in the highest risk group. The 28-day revisit rates across strata range from 16 % through 65 %, with the difference between strata being statistically highly significant (p <0.001). The area under the ROC curve is 0.65. We conclude that the risk nomogram can classify older people discharged from ED into risk strata, and has modest overall predictive value.

    AB - © 2015, SIMI. In older people, revisit to the emergency department (ED) in the short period after discharge is not entirely avoidable, but in a proportion of cases is preventable, and should ideally be minimised. We have previously derived a risk probability nomogram to predict the likelihood of revisit. In this study, we sought to validate the nomogram for use as a general risk stratification tool for use in older people being discharged from ED. We conducted a prospective cohort study, applying the nomogram to consecutive community dwelling discharged patients aged 65 and over. Patients were followed up at 28 days post-discharge to determine whether there had been any unplanned ED revisit in that period. We cross tabulated predicted risk versus revisit rates. In 1143 study subjects, we find the odds of revisit increases progressively with increasing strata of predicted risk, culminating in an OR of 9.7 (95 % CI 4.7–19.9) in the highest risk group. The 28-day revisit rates across strata range from 16 % through 65 %, with the difference between strata being statistically highly significant (p <0.001). The area under the ROC curve is 0.65. We conclude that the risk nomogram can classify older people discharged from ED into risk strata, and has modest overall predictive value.

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