6 research outputs found
External validation of LACE+ scores
BACKGROUND: Unplanned hospital readmissions are common adverse events. The LACE+ score
has been used to identify patients at the highest risk of unplanned readmission or death, yet
the external validity of this score remains uncertain.
METHODS: We constructed a cohort of patients admitted to hospital between October 1, 2014
and January 31, 2017 using population-based data from British Columbia (Canada). The primary
outcome was a composite of urgent hospital readmission or death within 30 days of index
discharge. The primary analysis sought to optimize clinical utility and international
generalizability by focusing on the modified LACE+ (mLACE+) score, a variation of the LACE+
score which excludes the Case Mix Group score. Predictive performance was assessed using
model calibration and discrimination.
RESULTS: Among 368,154 hospitalized individuals, 31,961 (8.7%) were urgently readmitted and
5,428 (1.5%) died within 30 days of index discharge (crude composite risk of readmission or
death, 9.95%). The mLACE+ score exhibited excellent calibration (calibration-in-the-large and
calibration slope no different than ideal) and adequate discrimination (c-statistic, 0.681; 95%CI,
0.678 to 0.684). Higher risk dichotomized mLACE+ scores were only modestly associated with
the primary outcome (positive likelihood ratio 1.95, 95%CI 1.93 to 1.97). Predictive
performance of the mLACE+ score was similar to that of the LACE+ and LACE scores. CONCLUSION: The mLACE+, LACE+ and LACE scores predict hospital readmission with excellent
calibration and adequate discrimination. These scores can be used to target interventions
designed to prevent unplanned hospital readmission.Medicine, Faculty ofNon UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherGraduat