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Validation of the HOSPITAL score as predictor of 30-day potentially avoidable readmissions in pediatric hospitalized population: retrospective cohort study

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Abstract

Potentially avoidable pediatric readmissions are a burden to patients and their families. Identifying patients with higher risk of readmission could help minimize hospital costs and facilitate the targeting of care interventions. HOSPITAL score is a tool developed and widely used to predict adult patient’s readmissions; however its predictive capacity for pediatric readmissions has not yet been evaluated. The aim of the study was to validate the HOSPITAL score application to predict 30-day potentially avoidable readmissions in a pediatric hospitalized population. This is a retrospective cohort study with patients under 18 years old admitted to a tertiary university hospital (n = 6,344). The HOSPITAL score was estimated for each admission. Subsequently, we classified the patients as low (0–4), intermediate (5–6), and high (7–12) risk groups. In order to estimate the discrimination power, the sensitivity, specificity, and accuracy were determined by the receiver operating characteristics (ROC) and the calibration by the Hosmer–Lemeshow goodness-of-fit. The 30-day hospital readmission was 11.70% (745). The accuracy was 0.80 (CI 95%, 0.77, 0.83), with a sensitivity of 70.96% and specificity of 78.29%, and a good calibration (p = 0.34).

   Conclusion: HOSPITAL score showed a good discrimination and can be used to predict 30-day potentially avoidable readmission in a large pediatric population with different medical diagnoses. Our study validates and expands the usefulness of the HOSPITAL score as a tool to predict avoidable hospital readmissions for pediatric population.

What is Known:

•   Pediatric readmissions burden patients, the family network, and the health system. In addition, it influences negatively child development.

•   The HOSPITAL score is one of the tools developed and widely used to identify patients at high risk of hospital readmission, but its predictive capacity for pediatric readmissions has not been yet assessed.

What is New:

• The HOSPITAL score showed good ability to identify a risk of 30-day potentially avoidable readmission in a pediatric population in different clinical contexts and diagnoses.

• Our study expands the usefulness of the HOSPITAL score as a tool for predicting hospital readmissions for children and adolescents.

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Data Availability

The data that support the findings of this study are available from the corresponding author, G.G.P, upon reasonable request.

Abbreviations

AUC:

Area under the curve

ICD:

International Statistical Classification of Diseases

IQR:

Interquartile ranges

ROC:

Receiver operating characteristic

SD:

Standard deviation

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Acknowledgements

We thank the technology and information center (CTI) team of the Clinical Hospital of the Federal University of Uberlandia for helping in database extraction. N.C.S received a doctoral fellowship from the “Foundation for Research Support of the State of Minas Gerais” (FAPEMIG – Fundação de Amparo à Pesquisa do Estado de Minas Gerais). André R. Backes gratefully acknowledges the financial support of CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico (Grant #307100/2021-9). Marcelo K. Albertini gratefully acknowledges the financial support of CNPq (Grant #406418/2021-7).

Funding

This study received financial support from “the Foundation for Research Support of the State of Minas Gerais” (FAPEMIG – Fundação de Amparo à Pesquisa do Estado de Minas Gerais) in a public call process number APQ-01331–21.The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, 38400-902, Brazil

    Nayara Cristina da Silva & Geórgia das Graças Pena

  2. School of Computer Science, Federal University of Uberlandia, Minas Gerais, 38408-100, Brazil

    Marcelo Keese Albertini

  3. Department of Computing, Federal Univeristy of Sao Carlos, São Carlos, São Paulo, 13565-905, Brazil

    André Ricardo Backes

Authors
  1. Nayara Cristina da Silva
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  2. Marcelo Keese Albertini
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  3. André Ricardo Backes
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  4. Geórgia das Graças Pena
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Contributions

Silva conceptualized and investigated the study, designed the methodology, performed the formal analyses and data curation of the study, drafted the initial manuscript, and reviewed the manuscript. Albertini conceptualized and investigated the study, and reviewed the manuscript. Backes conceptualized and investigated the study, and reviewed the manuscript. Pena conceptualized and investigated the study, designed the methodology, and reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Geórgia das Graças Pena.

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Ethics approval

The Research Ethics Committee of Federal University of Uberlandia approved this study (protocol number: 5.003.236).

Conflict of Interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

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da Silva, N.C., Albertini, M.K., Backes, A.R. et al. Validation of the HOSPITAL score as predictor of 30-day potentially avoidable readmissions in pediatric hospitalized population: retrospective cohort study. Eur J Pediatr 182, 1579–1585 (2023). https://doi.org/10.1007/s00431-022-04795-z

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