Development and validation of a risk score to predict unplanned hospital readmissions in ICU survivors: A data linkage study

Julia K. Pilowsky, Amy von Huben, Rosalind Elliott, Michael A. Roche

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Intensive Care Unit (ICU) follow-up clinics are growing in popularity internationally; however, there is limited evidence as to which patients would benefit most from a referral to this service. Objectives: The objective of this study was to develop and validate a model to predict which ICU survivors are most likely to experience an unplanned hospital readmission or death in the year after hospital discharge and derive a risk score capable of identifying high-risk patients who may benefit from referral to follow-up services. Methods: A multicentre, retrospective observational cohort study using linked administrative data from eight ICUs was conducted in the state of New South Wales, Australia. A logistic regression model was developed for the composite outcome of death or unplanned readmission in the 12 months after discharge from the index hospitalisation. Results: 12,862 ICU survivors were included in the study, of which 5940 (46.2%) patients experienced unplanned readmission or death. Strong predictors of readmission or death included the presence of a pre-existing mental health disorder (odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.40–1.65), severity of critical illness (OR: 1.57, 95% CI: 1.39–1.76), and two or more physical comorbidities (OR: 2.39, 95% CI: 2.14–2.68). The prediction model demonstrated reasonable discrimination (area under the receiver operating characteristic curve: 0.68, 95% CI: 0.67–0.69) and overall performance (scaled Brier score: 0.10). The risk score was capable of stratifying patients into three distinct risk groups—high (64.05% readmitted or died), medium (45.77% readmitted or died), and low (29.30% readmitted or died). Conclusions: Unplanned readmission or death is common amongst survivors of critical illness. The risk score presented here allows patients to be stratified by risk level, enabling targeted referral to preventative follow-up services.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalAustralian Critical Care
DOIs
Publication statusPublished - Jun 2023

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