Patient selection: admitted to the hospital with pneumonia
Outcome: 30-day all-cause readmission
Parameters:
(1) age in years
(2) history of cancer
(3) history of coronary heart disease (CHD)
(4) history of stroke
(5) time until first antibiotic administered in minutes
(6) therapy with opioids
(7) maximum temperature in °C during 24 hours after admission
(8) maximum serum albumin in g/dL during the 24 hours after admission
(9) maximum serum BUN in mg/dL in the last 24 hours prior to discharge
(10) minimum serum sodium in mmol/L in the last 24 hours prior to discharge
(11) minimum hemoglobin in g/dL in the last 24 hours prior to discharge
(12) minimum INR in the last 24 hours prior to discharge
(13) total number of prior admissions within the 6 months prior to admission
|
Parameter
|
Finding
|
Points
|
|
age in years
|
|
0.0143 * (age)
|
|
history of cancer
|
no
|
0
|
|
|
yes
|
0.229
|
|
history of CHD
|
no
|
0
|
|
|
yes
|
0.221
|
|
history of stroke
|
no
|
0
|
|
|
yes
|
-0.192
|
|
time to first antibiotic
|
|
0.140 * LN(time)
|
|
therapy with opioids
|
no
|
0
|
|
|
yes
|
0.375
|
|
maximum temperature
|
|
-0.104 * (temperature)
|
|
maximum BUN
|
|
0.308 * (BUN)
|
|
minimum sodium
|
|
-0.0358 * (sodium)
|
|
minimum hemoglobin
|
|
-0.130 * (hemoglobin)
|
|
minimum albumin
|
|
-0.342 * (albumin)
|
|
minimum INR
|
|
0.32 * (INR)
|
|
number of admissions
|
|
0.689 * (number)
|
where:
• The beta-coefficient for prior admissions is ambiguous. The coefficient associated with the odds ratio is 0.689. There is a second that was fitted with a restricted spline given as -1.03. There are 3 options - use the first, use the second, use both.
• Serum BUN appears to be a key predictor for readmission.
X =
= SUM(points for all 13 parameters) - 12.3
probability of readmission =
= 1/ (1+EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.71.
