Validation of the HOSPITAL score as predictor of 30-day potentially avoidable readmissions in pediatric hospitalized population: retrospective cohort study

Potentially avoidable pediatric readmissions are a burden to patients and their families. Identifying patients with higher risk of readmission could help minimize hospital costs and facilitate the targeting of care interventions. HOSPITAL score is a tool developed and widely used to predict adult patient's readmissions; however its predictive capacity for pediatric readmissions has not yet been evaluated. The aim of the study was to validate the HOSPITAL score application to predict 30-day potentially avoidable readmissions in a pediatric hospitalized population. This is a retrospective cohort study with patients under 18 years old admitted to a tertiary university hospital (n = 6,344). The HOSPITAL score was estimated for each admission. Subsequently, we classified the patients as low (0-4), intermediate (5-6), and high (7-12) risk groups. In order to estimate the discrimination power, the sensitivity, specificity, and accuracy were determined by the receiver operating characteristics (ROC) and the calibration by the Hosmer-Lemeshow goodness-of-fit. The 30-day hospital readmission was 11.70% (745). The accuracy was 0.80 (CI 95%, 0.77, 0.83), with a sensitivity of 70.96% and specificity of 78.29%, and a good calibration (p = 0.34).Conclusion: HOSPITAL score showed a good discrimination and can be used to predict 30-day potentially avoidable readmission in a large pediatric population with different medical diagnoses. Our study validates and expands the usefulness of the HOSPITAL score as a tool to predict avoidable hospital readmissions for pediatric population.