Validation of the HOSPITAL score as predictor of 30-day potentially avoidable readmissions in pediatric hospitalized population: retrospective cohort study.

Abstract

Potentially avoidable pediatric readmissions are a burden to patients and their families. Identifying patients with higher risk of readmission could help minimize hospital costs and facilitate the targeting of care interventions. HOSPITAL score is a tool developed and widely used to predict adult patient's readmissions; however its predictive capacity for pediatric readmissions has not yet been evaluated. The aim of the study was to validate the HOSPITAL score application to predict 30-day potentially avoidable readmissions in a pediatric hospitalized population. This is a retrospective cohort study with patients under 18years old admitted to a tertiary university hospital (n = 6,344). The HOSPITAL score was estimated for each admission. Subsequently, we classified the patients as low (0-4), intermediate (5-6), and high (7-12) risk groups. In order to estimate the discrimination power, the sensitivity, specificity, and accuracy were determined by the receiver operating characteristics (ROC) and the calibration by the Hosmer-Lemeshow goodness-of-fit. The 30-day hospital readmission was 11.70% (745). The accuracy was 0.80 (CI 95%, 0.77, 0.83), with a sensitivity of 70.96% and specificity of 78.29%, and a good calibration (p = 0.34). Conclusion: HOSPITAL score showed a good discrimination and can be used to predict 30-day potentially avoidable readmission in a large pediatric population with different medical diagnoses. Our study validates and expands the usefulness of the HOSPITAL score as a tool to predict avoidable hospital readmissions for pediatric population. What is Known: • Pediatric readmissions burden patients, the family network, and the health system. In addition, it influences negatively child development. • The HOSPITAL score is one of the tools developed and widely used to identify patients at high risk of hospital readmission, but its predictive capacity for pediatric readmissions has not been yet assessed. What is New: •The HOSPITAL score showed good ability to identify a risk of 30-day potentially avoidable readmission in a pediatric population in different clinical contexts and diagnoses. •Our study expands the usefulness of the HOSPITAL score as a tool for predicting hospital readmissions for children and adolescents.