Extending the Sydney Triage to Admission Risk Tool (START+) to predict discharges and short stay admissions

Abstract

ACTRN12618000426280.

Admission prediction rules: some limited promise, but far from proven

“…In their recent study from Australia, Ebker-White et al  validate the Sydney Triage to Admission Risk Tool (START) previously designed for early identification of ED patients who will be discharged 1. The authors then develop an extended tool (START+) to identify patients expected to have lengths of stay of under 48 hours, that is, discharged directly from the ED or from short-stay units.…”

“…The results of the START+ study reveal that it is likely more useful to identify short-stay/discharged patients than admitted patients: Only 2.5% classified as ‘very likely’ or ‘likely’ discharge/short stay were admitted, while 63.1% of patients classified as ‘likely’ or ‘very likely’ admission were discharged 1. Of note, the rule does not distinguish between short stay and discharge, calling into question its utility in streamlining patients to short-stay units.…”

Development and Internal Validation of a Model Predicting Safe, Early Discharge Among Patients Presenting to the Emergency Department with an Infection.

“…Several studies have focused on predicting early discharge among speci c patient populations [35,36,[53][54][55][56][57][58] and multiple have proposed prediction models. [36,[55][56][57][58] Only two, however, based their prediction model on ED patients. [57,58] The rst included 894 general ED patients and showed an AUC of 0.84 for the prediction of discharge within 48…”

“…[36,[55][56][57][58] Only two, however, based their prediction model on ED patients. [57,58] The rst included 894 general ED patients and showed an AUC of 0.84 for the prediction of discharge within 48…”

“…hours. [57] The second included 297 general ED patients and demonstrated an AUC of 0.68 for the prediction of discharge within 72 hours. [58] Neither, however, analyzed the safety of these early discharges.…”