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    LACE Index for Readmission

    Predicts 30-day readmission or death in patients on medicine and surgery wards.
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    INSTRUCTIONS

    Use in patients ≥18 years old.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients admitted to medical or surgical wards.

    • Length of stay cannot be factored in until day of discharge, thus limiting real-time use.
    • Note that mean age of study participants was 61 years in the derivation LACE study.
    • Validated for use in congestive heart failure patients.
    • Can identify patients that might benefit from post-discharge nursing care.
    • Predicts rates of readmission, with some studies identifying the number of ED visits in 6 months which is a component of the LACE as the major predictor of readmission.
    • Has similar discriminating ability as other scores such as the HOSPITAL score and 8Ps.
    About the Creator
    Dr. Carl van Walraven
    Content Contributors
    • Chukwudi Obiagwu, MBBS

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Consider post discharge visits for medication reconciliation and adherence check in heart failure patients with higher LACE scores.

    Formula

     

    Attribute

    Value

    Points

    L: Length of stay (days)

    <1

    1

    2

    3

    4-6

    7-13

    ≥14

    0

    1

    2

    3

    4

    5

    7

    A: Acute (emergent) admission

    Yes

    No

    3

    0

    C: Charlson Comorbidity Index

    0

    1

    2

    3

    ≥4

    0

    1

    2

    3

    5

    E: Visits to emergency department during previous 6 months (not including ED visit of current admission)

    1

    2

    3

    ≥4

    1

    2

    3

    4 

    In this study, Charlson Comorbidity Index was calculated by adding points as follows:

    1 point

    • History of myocardial infarction.
    • Peripheral vascular disease.
    • Cerebrovascular disease.
    • Diabetes without complications.

    2 points

    • Congestive heart failure.
    • Chronic obstructive pulmonary disease.
    • Mild liver disease or cancer.

    3 points

    • Dementia.
    • Connective tissue disease.

    4 points

    • Moderate to severe liver disease.
    • HIV infection.

    6 points

    • Metastatic cancer.

    From Walraven et al 2010.

    Facts & Figures

    Score interpretation:

    LACE Index Score Risk
    0-4 points Low
    5-9 points Moderate
    >9 points High

    Evidence Appraisal

    In the seminal research by Walraven, Stiell and colleagues on 4812 patients in Ontario, a split-sample design was used to derive and validate the LACE Index to predict the risk of death or nonelective readmission within 30 days after discharge.

    This was externally validated using administrative data in a separate random selection of 1,000,000 Ontarians discharged from hospital. They found that 8% of the patients died or were readmitted within 30 days and that the LACE Index was very accurate at predicting this outcome.

    In a retrospective study by Wang et al, of 253 patients presenting with CHF exacerbation, 24.5% were readmitted within 30 days of discharge. The LACE Index was only slightly higher in those admitted versus not admitted (12.17 ± 2.22 vs. 11.80 ± 1.92, p = 0.199). Patients with high LACE Indices (≥10) did have significantly higher rates of readmission (15% vs. 0%) compared with those with low LACE Indices.

    Literature

    Dr. Carl van Walraven

    About the Creator

    Carl van Walraven, MD, is a professor of medicine and epidemiology at the University of Ottawa. He is also a senior scientist of the Clinical Epidemiology Program at the Ottawa Hospital Research Institute (OHRI) as well as a site director for the Institute for Clinical Evaluative Sciences at the University of Ottawa. He is an active researcher focusing mainly on quality improvement, continuity of care/information, and administrative database research.

    To view Dr. Carl van Walraven's publications, visit PubMed

    Content Contributors
    • Chukwudi Obiagwu, MBBS