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Background <p>Unplanned hospital readmissions not only negatively impact patients’ quality of life but also pose a substantial burden on both the hospital and the individuals. Hence, there is a growing need to identify and prevent avoidable readmissions, aiming to reduce mortality and enhance the quality of care. LACE index (<b>L</b>ength of stay, <b>A</b>cuity of the admission, <b>C</b>omorbidity of the patient, and <b>E</b>mergency department visits) and HOSPITAL scores (<b>H</b>emoglobin at discharge, discharge from an <b>O</b>ncology service, <b>S</b>odium level at discharge, <b>P</b>rocedure during index admission, <b>I</b>ndex <b>T</b>ype of admission, number of <b>A</b>dmissions during the last 12 months, and <b>L</b>ength of stay) are widely used tools to assess the risk of readmission. This study was conducted to determine if the LACE index and HOSPITAL Score are fair predictors of 30-day readmission in adult patients admitted to the internal medicine service at a tertiary care center in a lower-middle-income country (LMIC) like Pakistan.</p> Main body <p>This study employed a retrospective cohort study design. The study includes 35,496 patients, aged 18 and above, admitted to the internal medicine service (both from emergency room and elective admissions) at a tertiary care hospital in Karachi, Pakistan, for 5 years (2016–2020). Out of these patients, 8.0% (2,822) were readmitted within 30 days of their index-admission. The mean age of all patients was 55.3 years (S.D. = 18.9), with males constituting 53.4% (<i>n</i> = 18,958). Patients readmitted within 30 days demonstrated a higher mean LACE index compared to those not readmitted (8.9 vs. 7.4, p-value &lt; 0.001). Additionally, the mean HOSPITAL score was higher in patients readmitted within 30 days compared to those not readmitted (3.4 vs. 2.6, p-value &lt; 0.001). An ROC curve evaluation of the LACE index and HOSPITAL score for this population showed an AUC of 0.670 (95% CI = 0.65–0.69) and 0.655 (95% CI = 0.63–0.67), respectively.</p> Conclusion <p>The LACE index and HOSPITAL scores demonstrated fair discrimination in predicting readmissions in an LMIC hospital. This suggests their potential for improving early detection and intervention strategies to mitigate readmissions. This study concludes that both scores had comparable performances in an LMIC setting, guiding their adequate integration in routine healthcare systems workflows.</p>

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Assessing effectiveness of HOSPITAL score and LACE index for predicting 30-day readmissions in a tertiary care hospital in Pakistan: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月2日

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  • Manzar Abbas,
  • Hajra Arshad,
  • Muhammad Umar Mahar,
  • Javerya Hassan,
  • Izza Tahir,
  • Namra Aziz,
  • Lena Jafri,
  • Mehmood Riaz,
  • Aysha Almas

摘要

Background

Unplanned hospital readmissions not only negatively impact patients’ quality of life but also pose a substantial burden on both the hospital and the individuals. Hence, there is a growing need to identify and prevent avoidable readmissions, aiming to reduce mortality and enhance the quality of care. LACE index (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department visits) and HOSPITAL scores (Hemoglobin at discharge, discharge from an Oncology service, Sodium level at discharge, Procedure during index admission, Index Type of admission, number of Admissions during the last 12 months, and Length of stay) are widely used tools to assess the risk of readmission. This study was conducted to determine if the LACE index and HOSPITAL Score are fair predictors of 30-day readmission in adult patients admitted to the internal medicine service at a tertiary care center in a lower-middle-income country (LMIC) like Pakistan.

Main body

This study employed a retrospective cohort study design. The study includes 35,496 patients, aged 18 and above, admitted to the internal medicine service (both from emergency room and elective admissions) at a tertiary care hospital in Karachi, Pakistan, for 5 years (2016–2020). Out of these patients, 8.0% (2,822) were readmitted within 30 days of their index-admission. The mean age of all patients was 55.3 years (S.D. = 18.9), with males constituting 53.4% (n = 18,958). Patients readmitted within 30 days demonstrated a higher mean LACE index compared to those not readmitted (8.9 vs. 7.4, p-value < 0.001). Additionally, the mean HOSPITAL score was higher in patients readmitted within 30 days compared to those not readmitted (3.4 vs. 2.6, p-value < 0.001). An ROC curve evaluation of the LACE index and HOSPITAL score for this population showed an AUC of 0.670 (95% CI = 0.65–0.69) and 0.655 (95% CI = 0.63–0.67), respectively.

Conclusion

The LACE index and HOSPITAL scores demonstrated fair discrimination in predicting readmissions in an LMIC hospital. This suggests their potential for improving early detection and intervention strategies to mitigate readmissions. This study concludes that both scores had comparable performances in an LMIC setting, guiding their adequate integration in routine healthcare systems workflows.