The Early HOSPITAL Score to Predict 30-Day Readmission Soon After Hospitalization: a Prospective Multicenter Study

Area of Science:

• Healthcare research
• Clinical prediction models
• Patient readmission studies

Background:

• The simplified HOSPITAL score aids in predicting 30-day patient readmissions.
• Early risk stratification enables better preparation for transitional care.

Purpose of the Study:

• To evaluate the performance of the simplified HOSPITAL score using admission laboratory values (hemoglobin, sodium) versus discharge values.
• To determine if using admission data impacts the score's accuracy in predicting readmissions.

Main Methods:

• Prospective national multicentric cohort study involving 934 medical inpatients.
• Compared simplified HOSPITAL score (discharge labs) with an early version (admission labs).
• Assessed performance using Area Under the Receiver Operating characteristic Curve (AUROC) and Net Reclassification Improvement (NRI) for 30-day readmission or death.

Main Results:

• The early HOSPITAL score demonstrated comparable accuracy to the simplified score (AUROC 0.66 for both).
• A statistically significant improvement in classification was observed with the early score using Net Reclassification Improvement (NRI: 0.28, p=0.004).
• 13.2% of patients experienced 30-day unplanned readmission or death.

Conclusions:

• The early HOSPITAL score performs similarly to the discharge-based score in identifying high-risk patients.
• Utilizing admission laboratory values allows for earlier risk stratification.
• This facilitates timely transitional care interventions for patients who would benefit most.