Deriving a prediction rule for short stay admission in trauma patients admitted at a major trauma centre in Australia

Abstract

IntroductionThe aim of this study was to derive and internally validate a prediction rule for short stay admissions (SSAs) in trauma patients admitted to a major trauma centre. Methods A retrospective study of all trauma activation patients requiring inpatient admission at a single inner city major trauma centre in Australia between 2007 and 2011 was conducted. Logistic regression was used to derive a multivariable model for the outcome of SSA (length of stay ≤2 days excluding deaths or intensive care unit admission). Model discrimination was tested using area under receiver operator characteristic curve analyses and calibration was tested using the HosmerLemeshow test statistic. Validation was performed by splitting the dataset into derivation and validation datasets and further tested using bootstrap cross validation. Results A total of 2593 patients were studied and 30% were classified as SSAs. Important independent predictors of SSA were injury severity score ≤8 (OR 7.8; 95% CI 5.0 to 11.9), Glasgow coma score 14-15 (OR 3.2; 95% CI 1.8 to 5.4), no need for operative intervention (OR 2.2; 95% CI 1.6 to 3.2) and age < 65 years. (OR 1.7; 95% CI 1.2 to 2.6). The overall model had an area under receiver operator characteristic curve of 0.84 (95% CI 0.82 to 0.87) for the derivation dataset. After bootstrap cross validation the area under the curve of the final model was 0.83 (95% CI 0.81 to 0.84). Conclusions We report a prediction rule that could be used to establish admission criteria for a trauma short stay unit. Further studies are required to prospectively validate the prediction rule.

Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study

“…We selected these patient characteristics because patient age, illness severity and level of comorbidity have all been associated with a longer hospital stay. [10][11][12][13][14][15][16] Fiscal year was included to account for secular trends in hospital length of stay. Physician characteristics included years since medical school graduation and sex because physician experience and sex have been associated with differences in physician practice and quality of inpatient care.…”