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

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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.

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Acknowledgments

CCT members at each site provided invaluable assistance with the study. Mr Michael Phillips and Ms Sally Burrows assisted with statistical analysis. The research was funded by a grant from the State Health Research Advisory Council of Western Australia.

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Authors and Affiliations

  1. Centre for Clinical Research in Emergency Medicine (CCREM), Western Australian Institute for Medical Research, Level 5 MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia

    Glenn Arendts

  2. School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Australia

    Glenn Arendts, Sarah Fitzhardinge, Karren Pronk & Yusuf Nagree

  3. Western Australian Department of Health, South Metropolitan Health Service, Fremantle, Australia

    Marani Hutton

  4. Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia

    Mark Donaldson

Authors
  1. Glenn Arendts
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  2. Sarah Fitzhardinge
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  3. Karren Pronk
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  4. Marani Hutton
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  5. Yusuf Nagree
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  6. Mark Donaldson
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Correspondence to Glenn Arendts.

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Arendts, G., Fitzhardinge, S., Pronk, K. et al. Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department. Intern Emerg Med 8, 249–254 (2013). https://doi.org/10.1007/s11739-012-0895-5

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  • DOI: https://doi.org/10.1007/s11739-012-0895-5

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