Internal and Emergency Medicine

, Volume 8, Issue 3, pp 249–254

Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department

  • Glenn Arendts
  • Sarah Fitzhardinge
  • Karren Pronk
  • Marani Hutton
  • Yusuf Nagree
  • Mark Donaldson
EM - ORIGINAL

DOI: 10.1007/s11739-012-0895-5

Cite this article as:
Arendts, G., Fitzhardinge, S., Pronk, K. et al. Intern Emerg Med (2013) 8: 249. doi:10.1007/s11739-012-0895-5

Abstract

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation.

Keywords

Emergency departmentRevisitRisk assessmentDischarge planningAllied health personnel

Supplementary material

11739_2012_895_MOESM1_ESM.xlsx (13 kb)
Supplementary material 1 (XLSX 13 kb)

Copyright information

© SIMI 2013

Authors and Affiliations

  • Glenn Arendts
    • 1
    • 2
  • Sarah Fitzhardinge
    • 2
  • Karren Pronk
    • 2
  • Marani Hutton
    • 3
  • Yusuf Nagree
    • 2
  • Mark Donaldson
    • 4
  1. 1.Centre for Clinical Research in Emergency Medicine (CCREM), Western Australian Institute for Medical ResearchPerthAustralia
  2. 2.School of Primary, Aboriginal and Rural Health Care, University of Western AustraliaCrawleyAustralia
  3. 3.Western Australian Department of HealthSouth Metropolitan Health ServiceFremantleAustralia
  4. 4.Department of Geriatric MedicineRoyal Perth HospitalPerthAustralia