title: Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department.
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.
authors: 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@uwa.edu.au
authors: Glenn
authors: G
authors: Arendts
authors: Sarah
authors: S
authors: Fitzhardinge
authors: Karren
authors: K
authors: Pronk
authors: Marani
authors: M
authors: Hutton
authors: Yusuf
authors: Y
authors: Nagree
authors: Mark
authors: M
authors: Donaldson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D049451:Nomograms; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors