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LACE Index for Readmission

Calculators  Infectious Diseases
LACE Index is a effective tool which is used to detect 30-day readmission or death in patients on medicine and surgery wards
Length of stay (days)
1 1
2 2
3 3
4-6 4
7-13 5
≥14 7
Acute (emergent) admission
No 0
Yes 3
0 points 0
1 points 1
2 points 2
3 points 3
≥4 points 5
Number of ED visits within 6 months
Not including ED visit of current admission
0 0
1 1
2 2
3 3
≥4 4
Result:

Background

Measured Factor
Risk of death or nonelective readmission within 30 days after discharge
Measured Factor Disease
  • Risk of readmission or death
Measured Factor Detail
LACE Index test is used to assess the risk of readmission or death within 30 days after discharge from hospital. There are 4 factors taken into consideration for calculation of score such as length of stay, Charlson Comorbidity Index, number of visits to emergency department during previous 6 months, acute (emergent) admission. It is particularly used in patients ≥18 years old.
Speciality
Multi-Speciality
Body System
Infectious Diseases
Measured Factor Low Impact
  • LACE Index Score of 0-4 points indicates low risk of readmission.
Measured Factor High Impact
  • LACE Index Score of >9 points illustrates high risk of readmission.

Result Interpretation

Ranges Ranges
  • Critical Low: 0-4 points
  • Critical High: >9 points
Test Limitations
LACE index has poor predictive ability to identify elderly patients with readmission at high risk with 0.595 c-statistic and 0.628 final logistic regression model.
References: 2

Studies

Study Validation 1
A validation study of LACE index for readmission of medical patients. In 30 days, 12.6% patients were readmitted to the hospital from 26045 patients and 20.9% patients were readmitted after 90 days of discharge from the hospital. 34% patients were at high risk, LACE > or = 10 but 51.7% patients were readmitted within 30 days. Patients having high risk were readmitted twice in frequency as compared to other patients, also during readmission more likely to die. In addition, study validate that LACE index is more useful tool for aid in post-discharge interventions.
References: 3
Study Validation 2
A study was conducted to validate LACE index for readmission of medical patients. In 30 days, 385 (8%) patients were readmitted to the hospital from 4812 patients. LACE index range from 0-19 (2% expectancy of readmission or death within 30 days and 43.7% risk respectively). The LACE index was very accurate with p = 0.59 and C statistic 0.684. In addition, study validate that LACE index is more useful tool for aid in post-discharge interventions.
References: 4
Study Validation 3
A study was conducted to validate accuracy of LACE index for readmission of congestive heart failure patients. In 30 days, 62 (24.50%) patients were readmitted to the hospital from 253 patients after discharge. Readmitted patients had higher LACE index as compared to not readmitted patients. LACE index range > or = 10 patients had high risk with 15.04% vs 0% of hospital readmission within 30 days (p = 0.030) as compared to low risk patients. In addition, study validate that LACE index is more useful tool for aid in post-discharge interventions.
References: 5
Study Additional 1
A study was conducted in Singapore with LACE index for readmission of elderly patients. In 30 days, 2051 (12.1%) patients were readmitted to Singapore general hospital from 17006 patients after discharge. Readmitted patients had higher LACE index as compared to not readmitted patients. LACE index had poor predictive ability to identify elderly patients with readmission at high risk. LACE index had 0.595 c-statistic and 0.628 final logistic regression model. In addition, the study assesses that LACE index is a poor tool for elderly patients in post-discharge interventions.
References: 2
Study Additional 2
A study was conducted with LACE index for readmission of congestive heart failure patients. 48 patients in checklist were compared with control group of randomly selected 48 patients. Angiotensin receptor blockers (ARBs) or Angiotensin-converting enzyme (ACE) inhibitors taking checklist patients were compared with control group with p < 0.001 (40 of 48 vs 23 of 48). Readmission of checklist patients was lower with 19-6% in 30 days to 42-23% in 6 months. In addition, study assesses that with the help of LACE index checklist patients decreased to readmission.
References: 6

References

  1. Carl van Walraven, Irfan A. Dhalla, Chaim Bell, Edward Etchells, Ian G. Stiell, Kelly Zarnke, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ : Canadian Medical Association Journal. 2010;182(6):551-557.
  2. Low LL, Liu N, Ong MEH, Ng EY, Ho AFW, Thumboo J, et al. Performance of the LACE index to identify elderly patients at high risk for hospital readmission in Singapore. Medicine (Baltimore). 2017;96(19):e6728.
  3. Gruneir A, Dhalla IA, Van walraven C, Fischer HD, Camacho X, Rochon PA, et al. Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm. Open Med. 2011;5(2):e104-11
  4. Van walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551-7.
  5. Wang H, Robinson RD, Johnson C, Zenarosa NR, Jayswal RD, Keithley J, et al. Using the LACE index to predict hospital readmissions in congestive heart failure patients. BMC Cardiovasc Disord. 2014;14:97.
  6. Basoor A, Doshi NC, Cotant JF, Saleh T, Todorov M, Choksi N, et al. Decreased readmissions and improved quality of care with the use of an inexpensive checklist in heart failure. Congest Heart Fail. 2013;19(4):200-6.