Related Experiment Video
Updated: Jun 8, 2026
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Independent validation of the prolonged length of stay score
Silvia Koton1, Ramon Luengo-Fernandez, Ziyah Mehta
1The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. koton@post.tau.ac.il
Insights
The Prolonged Length of Stay (PLOS) score accurately predicted prolonged hospital stays for stroke patients in a UK cohort. This validated the score
Area of Science:
- Neurology
- Health Services Research
Background:
- The Prolonged Length of Stay (PLOS) score was developed in Israel for acute stroke patients.
- Its performance needed validation in different healthcare systems.
Purpose of the Study:
- To evaluate the PLOS score's effectiveness in predicting prolonged hospital stays for stroke patients in a UK population-based cohort.
- To assess the score's generalizability across different healthcare settings.
Main Methods:
- Analysis of 434 ischemic stroke or intracerebral hemorrhage patients from the Oxford Vascular Study (OXVASC).
- Calculation of median length of stay (LOS) and rates of LOS ≥7 and ≥30 days.
- Assessment of model discrimination using the c-statistic and goodness of fit with the Hosmer-Lemeshow test.
Main Results:
- Median LOS and rates of prolonged stays (≥7 and ≥30 days) increased with higher PLOS scores.
- The PLOS score demonstrated good predictive ability (c-statistic 0.676-0.722) for prolonged LOS.
- The Hosmer-Lemeshow test indicated good calibration of the PLOS score.
Conclusions:
- The PLOS score effectively predicted prolonged length of stay in the UK-based OXVASC cohort.
- The score's utility extends beyond acute hospitalization prediction to total LOS.
- This validates the PLOS score for use in diverse stroke patient populations and healthcare systems.
Background:
The prolonged length of stay (PLOS) score has recently been derived and validated in 2 independent national cohorts of acute stroke patients in Israel. The present study aimed to determine the performance of the PLOS score in an independent population-based cohort of stroke patients in a health care system considerably different from that in which the score was derived.
Methods:
The study was performed on all 434 patients with ischemic stroke or intracerebral hemorrhage hospitalized during the first 5 years of the population-based Oxford Vascular Study (OXVASC) in Oxfordshire, UK. Median (interquartile range) length of stay (LOS) and rates of LOS ≥7 days and LOS ≥30 days by the PLOS score were calculated. Model discrimination was assessed by the c-statistic and goodness of fit was evaluated with the Hosmer-Lemeshow test.
Results:
Median LOS and rates of LOS ≥7 days increased with the increase in PLOS score among all inpatients and hospital survivors. In the analysis of LOS ≥7 days, the PLOS c-statistic (95% CI) was 0.676 (0.618-0.734) for all inpatients and 0.722 (0.664-0.779) for hospital survivors. Findings were similar for LOS ≥30 days. The Hosmer-Lemeshow showed good calibration.
Conclusions:
The PLOS score successfully predicted PLOS in the OXVASC population of acute stroke patients. Although the score was originally derived for the prediction of prolonged acute hospitalization, it successfully predicted prolonged total LOS.