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Internal and Emergency Medicine
Published in: Internal and Emergency Medicine 3/2013

01-04-2013 | EM - ORIGINAL

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

Authors: Glenn Arendts, Sarah Fitzhardinge, Karren Pronk, Marani Hutton, Yusuf Nagree, Mark Donaldson

Published in: Internal and Emergency Medicine | Issue 3/2013

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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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Metadata
Title
Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department
Authors
Glenn Arendts
Sarah Fitzhardinge
Karren Pronk
Marani Hutton
Yusuf Nagree
Mark Donaldson
Publication date
01-04-2013
Publisher
Springer Milan
Published in
Internal and Emergency Medicine / Issue 3/2013
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-012-0895-5

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