Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score
Abstract Background The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify h...
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BMC
2025-02-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-025-01184-1 |
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| author | Chung-Ting Chen Po-Hsiang Liao Meng-Chen Lin Hsien-Hao Huang Chorng-Kuang How Yu-Chi Tung |
| author_facet | Chung-Ting Chen Po-Hsiang Liao Meng-Chen Lin Hsien-Hao Huang Chorng-Kuang How Yu-Chi Tung |
| author_sort | Chung-Ting Chen |
| collection | DOAJ |
| description | Abstract Background The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management. Methods This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return. Results On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760–0.871, p < 0.001) in the development dataset and 0.804 (0.750–0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0–8.5], moderate [9–11.5] and high [12–22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the Cochran‒Armitage trend test. Conclusion The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information. |
| format | Article |
| id | doaj-art-d40fc37c3e7d4eaeb60c98c8a8a741c8 |
| institution | OA Journals |
| issn | 1471-227X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-d40fc37c3e7d4eaeb60c98c8a8a741c82025-08-20T02:13:19ZengBMCBMC Emergency Medicine1471-227X2025-02-0125111010.1186/s12873-025-01184-1Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 scoreChung-Ting Chen0Po-Hsiang Liao1Meng-Chen Lin2Hsien-Hao Huang3Chorng-Kuang How4Yu-Chi Tung5Emergency Department, Taipei Veterans General HospitalEmergency Department, Taipei Veterans General HospitalNursing Department, Taipei Veterans General HospitalEmergency Department, Taipei Veterans General HospitalEmergency Department, Taipei Veterans General HospitalInstitute of Health Policy and Management, College of Public Health, National Taiwan UniversityAbstract Background The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management. Methods This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return. Results On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760–0.871, p < 0.001) in the development dataset and 0.804 (0.750–0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0–8.5], moderate [9–11.5] and high [12–22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the Cochran‒Armitage trend test. Conclusion The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information.https://doi.org/10.1186/s12873-025-01184-1Emergency department revisitEmergency department returnMortalityPrediction modelRisk scoreQuality measure |
| spellingShingle | Chung-Ting Chen Po-Hsiang Liao Meng-Chen Lin Hsien-Hao Huang Chorng-Kuang How Yu-Chi Tung Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score BMC Emergency Medicine Emergency department revisit Emergency department return Mortality Prediction model Risk score Quality measure |
| title | Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score |
| title_full | Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score |
| title_fullStr | Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score |
| title_full_unstemmed | Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score |
| title_short | Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score |
| title_sort | predicting high risk return at emergency department presentation for patients who undergo short term revisits the handle 24 score |
| topic | Emergency department revisit Emergency department return Mortality Prediction model Risk score Quality measure |
| url | https://doi.org/10.1186/s12873-025-01184-1 |
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