New Index Helps Predict Early Death or Hospital Readmission

The participants were middle-aged, almost 95% were independent in daily living routines, and most were free of comorbidities; none of the participants were residents of nursing homes. The most common reasons for hospitalization were acute coronary syndromes (ACS), cancer diagnoses and complications, and heart failure. During the first 30 days after discharge from hospital, 8% (385) of the patients died or were urgently readmitted; of these, 9.4% (36) died and 90.4% (349) had unplanned readmissions.

The researchers found that the key factors associated with these events were length of stay (L), acuity of admission (A), patient comorbidity (C), and number of visits to the emergency room (E). From these factors, the researchers derived the LACE index for easy recall, which has a potential score of 0 (2% expected risk of death or urgent readmission within 30 days) to 19 (43.7% expected risk). The researchers warn, however, that though the index tool is easy to use, it is difficult to memorize and necessitates a computational aid. By using the LACE index, clinicians can quantify the risk of early death or unplanned readmission after discharge, and the tool could also be useful in focusing post-discharge support on patients that show the highest risk of poor outcomes. The index was externally validated using administrative data in a random selection of 1,000,000 citizens of Ontario (Canada) discharged from hospitals between 2004 and 2008. The study was published ahead of print on March 8, 2010, in the Canadian Medical Association Journal (CMAJ).

"We believe that the LACE index can be used by clinicians, researchers and administrators to predict the risk of early death or unplanned readmission of cognitively intact medical or surgical patients after discharge from the hospital to the community,” concluded lead author Carl Van Walraven, M.D., of the OHRI, and colleagues. "We have derived and validated an easy-to-use index that is moderately discriminative and very accurate for predicting the risk of early death or unplanned readmission after discharge from hospital to the community.”

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Ottawa Hospital Research Institute
University of Ottawa