Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer
Background and purpose: Emergency department (ED) admissions by cancer patients often result in hospitalization and prolonged ED stays, contributing to overcrowding. Early identification of patients at risk of hospitalization could improve ED flow and ensure timely provision of oncological care. Thi...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | ESMO Real World Data and Digital Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S294982012500030X |
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| author | Z.L.R. Kaplan D. van Klaveren J.G.A. den Duijn R.J.C.G. Verdonschot N. Wlazlo J.G.J.V. Aerts J. Bromberg H.F. Lingsma J. Alsma M.M.E.M. Bos |
| author_facet | Z.L.R. Kaplan D. van Klaveren J.G.A. den Duijn R.J.C.G. Verdonschot N. Wlazlo J.G.J.V. Aerts J. Bromberg H.F. Lingsma J. Alsma M.M.E.M. Bos |
| author_sort | Z.L.R. Kaplan |
| collection | DOAJ |
| description | Background and purpose: Emergency department (ED) admissions by cancer patients often result in hospitalization and prolonged ED stays, contributing to overcrowding. Early identification of patients at risk of hospitalization could improve ED flow and ensure timely provision of oncological care. This study aimed to develop and validate models to predict hospitalization among cancer patients admitted to the ED. Methods: Adult cancer patients who were admitted to the ED between 1 July 2018 and 30 September 2020 at the Erasmus University Medical Center were included. Data from electronic health records (EHR) were used to develop two logistic regression models: (i) a baseline model including predictors available after ED triage (e.g. patient characteristics, vital parameters) and (ii) an extended model including blood test results. Predictors were selected using the Wald χ2 statistic. To prevent overfitting, a uniform shrinkage factor was applied. Model performance was assessed with temporal validation (1 October 2019 to 1 January 2020) and evaluated with calibration plots and C-statistics. Results: Of 7284 ED admissions, 3967 (54%) resulted in hospitalization. The most common cancers requiring hospitalization were lung, hepatopancreatobiliary, and colorectal cancer. The baseline model included age, sex, primary malignancy, symptoms, metastasis, temperature, pain score, diastolic blood pressure, and heart rate. The model showed good calibration (intercept −0.04, slope 0.86) and discriminative ability [C-statistic 0.71, 95% confidence interval (CI) 0.68-0.74]. The extended model showed improved performance (intercept −0.09, slope 0.92; C-statistic 0.75, 95% CI 0.72-0.78). Conclusion: Hospitalization risk of cancer patients admitted to the ED can be predicted using routinely collected EHR data, which could aid in optimizing ED patient flow and ensuring timely provision of oncological services. |
| format | Article |
| id | doaj-art-b90161249b71464c85a948aaa6460b0d |
| institution | OA Journals |
| issn | 2949-8201 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | ESMO Real World Data and Digital Oncology |
| spelling | doaj-art-b90161249b71464c85a948aaa6460b0d2025-08-20T01:51:13ZengElsevierESMO Real World Data and Digital Oncology2949-82012025-06-01810014110.1016/j.esmorw.2025.100141Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancerZ.L.R. Kaplan0D. van Klaveren1J.G.A. den Duijn2R.J.C.G. Verdonschot3N. Wlazlo4J.G.J.V. Aerts5J. Bromberg6H.F. Lingsma7J. Alsma8M.M.E.M. Bos9Department of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Correspondence to: Dr Z. L. Rana Kaplan, MD, Department of Public Health, Erasmus University Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. Tel: +31-10-704-07-04Department of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine—Section Acute Medicine, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Emergency Department, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Hematology, Erasmus University Medical Center, University Medical Center Cancer Institute, Rotterdam, The NetherlandsDepartment of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Neurology, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Internal Medicine—Section Acute Medicine, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Medical Oncology, Erasmus University Medical Center, Rotterdam, The NetherlandsBackground and purpose: Emergency department (ED) admissions by cancer patients often result in hospitalization and prolonged ED stays, contributing to overcrowding. Early identification of patients at risk of hospitalization could improve ED flow and ensure timely provision of oncological care. This study aimed to develop and validate models to predict hospitalization among cancer patients admitted to the ED. Methods: Adult cancer patients who were admitted to the ED between 1 July 2018 and 30 September 2020 at the Erasmus University Medical Center were included. Data from electronic health records (EHR) were used to develop two logistic regression models: (i) a baseline model including predictors available after ED triage (e.g. patient characteristics, vital parameters) and (ii) an extended model including blood test results. Predictors were selected using the Wald χ2 statistic. To prevent overfitting, a uniform shrinkage factor was applied. Model performance was assessed with temporal validation (1 October 2019 to 1 January 2020) and evaluated with calibration plots and C-statistics. Results: Of 7284 ED admissions, 3967 (54%) resulted in hospitalization. The most common cancers requiring hospitalization were lung, hepatopancreatobiliary, and colorectal cancer. The baseline model included age, sex, primary malignancy, symptoms, metastasis, temperature, pain score, diastolic blood pressure, and heart rate. The model showed good calibration (intercept −0.04, slope 0.86) and discriminative ability [C-statistic 0.71, 95% confidence interval (CI) 0.68-0.74]. The extended model showed improved performance (intercept −0.09, slope 0.92; C-statistic 0.75, 95% CI 0.72-0.78). Conclusion: Hospitalization risk of cancer patients admitted to the ED can be predicted using routinely collected EHR data, which could aid in optimizing ED patient flow and ensuring timely provision of oncological services.http://www.sciencedirect.com/science/article/pii/S294982012500030Xoncological emergencyclinical prediction modelhospitalizationcare efficiency |
| spellingShingle | Z.L.R. Kaplan D. van Klaveren J.G.A. den Duijn R.J.C.G. Verdonschot N. Wlazlo J.G.J.V. Aerts J. Bromberg H.F. Lingsma J. Alsma M.M.E.M. Bos Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer ESMO Real World Data and Digital Oncology oncological emergency clinical prediction model hospitalization care efficiency |
| title | Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| title_full | Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| title_fullStr | Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| title_full_unstemmed | Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| title_short | Development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| title_sort | development and validation of a clinical prediction model for hospitalization after emergency department admission in patients with cancer |
| topic | oncological emergency clinical prediction model hospitalization care efficiency |
| url | http://www.sciencedirect.com/science/article/pii/S294982012500030X |
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