Risk factors for readmissions in children differ from those for adults, yet little is known about whether the LACE index (Length of stay, Acute admission, Charlson comorbidity index, Emergency department visits in the previous 6 months) developed for adults retains its validity when applied to the prediction of readmissions in children or within shorter intervals of time after discharge.
In this retrospective cohort analysis of 4 256 patients aged≤18 hospitalized at one academic medical center in Taiwan, 2019, we first evaluated the performance of a LACE index model and the three other multivariate logistic regression models in their predictions of hospital readmissions in children using the same time intervals of 30 days. We then used multinomial logistic regression to analyze the characteristics and risk factors for readmissions that occur in the first 14 days with those that occur between 15 to 30 days after discharge.
The optimal cutoff of LACE index score for children in the current study was 7, which is less than the optimal score of 10 in the original derivation for adults. The predictive model with the least discriminatory power was based on LACE score alone, whereas our model that included only two variables (length of stay and the number of admissions in the past one year) was found to outperform LACE index. Multinomial logistic regression results revealed that children who had supplemental private health insurance had lower readmission rates than those insured by National Health Insurance program only, suggesting a disparity by insurance status. Some risk factors of readmission within 14 days such as acute admissions and supplemental private health insurance were not found to be relevant for longer-term predictions, while age, which was a valid predictor of readmission within 15 to 30 days, did not affect the prediction of shorter-term readmissions. Prior healthcare utilizations and a higher illness burden were found to be greater contributors to readmissions beyond 14 days.
Our simpler model outperformed the more complex LACE tool in identifying children at risk of readmission. Shorter-term readmissions can be attributed to different causes than 30-day readmissions, suggesting a need for different screening tools, interventions, and care support. There remains some socioeconomic disparity associated with readmission rates in the current healthcare system.