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West J Emerg Med. 2018 Sep;19(5):842-848. doi: 10.5811/westjem.2018.7.37945. Epub 2018 Aug 13.

A Risk Score to Predict Short-term Outcomes Following Emergency Department Discharge.

Author information

1
University of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California.
2
Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California.
3
University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, California.
4
University of California, Los Angeles, Department of Medicine, Los Angeles, California.
5
Greater Los Angeles Veterans Affairs Healthcare System, Department of Medicine, Los Angeles, California.

Abstract

Introduction:

The emergency department (ED) is an inherently high-risk setting. Risk scores can help practitioners understand the risk of ED patients for developing poor outcomes after discharge. Our objective was to develop two risk scores that predict either general inpatient admission or death/intensive care unit (ICU) admission within seven days of ED discharge.

Methods:

We conducted a retrospective cohort study of patients age > 65 years using clinical data from a regional, integrated health system for years 2009-2010 to create risk scores to predict two outcomes, a general inpatient admission or death/ICU admission. We used logistic regression to predict the two outcomes based on age, body mass index, vital signs, Charlson comorbidity index (CCI), ED length of stay (LOS), and prior inpatient admission.

Results:

Of 104,025 ED visit discharges, 4,638 (4.5%) experienced a general inpatient admission and 531 (0.5%) death or ICU admission within seven days of discharge. Risk factors with the greatest point value for either outcome were high CCI score and a prolonged ED LOS. The C-statistic was 0.68 and 0.76 for the two models.

Conclusion:

Risk scores were successfully created for both outcomes from an integrated health system, inpatient admission or death/ICU admission. Patients who accrued the highest number of points and greatest risk present to the ED with a high number of comorbidities and require prolonged ED evaluations.

PMID:
30202497
PMCID:
PMC6123082
DOI:
10.5811/westjem.2018.7.37945
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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