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

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Abstract

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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Acknowledgments

This research was funded by a grant from the State health Research Advisory Council of Western Australia.

Conflict of interest

Authors RJ, KB, SD and MH are employees of the Western Australian State Government that funded the research through the State Health Research Advisory Council. All other authors declare they have no conflicts of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. University of Western Australia, Crawley, Australia

    Glenn Arendts, Christopher Etherton-Beer, Simon G. A. Brown & Osvaldo P. Almeida

  2. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute, MRF Building, Royal Perth Hospital, Perth, Australia

    Glenn Arendts, Ellen MacDonald & Simon G. A. Brown

  3. Western Australian Centre for Health and Ageing, Harry Perkins Institute, Perth, Australia

    Christopher Etherton-Beer & Osvaldo P. Almeida

  4. South Metropolitan Health Service, Perth, Australia

    Roslyn Jones, Kate Bullow, Sandra Dumas & Marani Hutton

  5. North Metropolitan Health Service, Perth, Australia

    Daniel Parker

  6. Medical Research Foundation, Royal Perth Hospital, Perth, Australia

    Sally Burrows

Authors
  1. Glenn Arendts
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  2. Christopher Etherton-Beer
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  3. Roslyn Jones
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  4. Kate Bullow
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  5. Ellen MacDonald
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  6. Sandra Dumas
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  7. Daniel Parker
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  8. Marani Hutton
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  9. Sally Burrows
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  10. Simon G. A. Brown
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  11. Osvaldo P. Almeida
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Corresponding author

Correspondence to Glenn Arendts.

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Arendts, G., Etherton-Beer, C., Jones, R. et al. Use of a risk nomogram to predict emergency department reattendance in older people after discharge: a validation study. Intern Emerg Med 10, 481–487 (2015). https://doi.org/10.1007/s11739-015-1219-3

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  • DOI: https://doi.org/10.1007/s11739-015-1219-3

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