scholarly journals External validation of the detection of indicators and vulnerabilities for emergency room trips (DIVERT) scale: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fabrice I. Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew P. Costa
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Discriminative Ability ◽  
Geographical Regions

Abstract Background The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients. Methods We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories between April 1, 2011 and September 30, 2014. The DIVERT scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was ED visitation within 6 months of a RAI-HC assessment. Results The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (< 1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC = 0.617–0.647), two or more ED visits (AUC = 0.628–0.634) and hospital admission (AUC = 0.617–0.664). Conclusions The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

scholarly journals External Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Fabrice Immanuel Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew Paul Costa
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Discriminative Ability ◽  
Geographical Regions

Abstract Background: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use in home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients.Methods: We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories, between April 1, 2011 and September 30, 2014. The DIVERT Scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was an ED visit within six months of a RAI-HC assessment.Results: The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (<1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC =0.617-0.647), two or more ED visits (AUC = 0.628-0.634), and hospital admission (AUC = 0.617-0.664).Conclusions: The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

scholarly journals External Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Fabrice Immanuel Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew Paul Costa
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Discriminative Ability ◽  
Geographical Regions

Abstract Background: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients. Methods: We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories between April 1, 2011 and September 30, 2014. The DIVERT scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study ED visitation within six months of a RAI-HC assessment. Results: The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (<1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC =0.617 - 0.647), two or more ED visits (AUC = 0.628 - 0.634), and hospital admission (AUC = 0.617 - 0.664). Conclusions: The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

scholarly journals External Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Fabrice Immanuel Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew Paul Costa
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Geographical Regions

Abstract Background: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use in home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients. Methods: We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories, between April 1, 2011 and September 30, 2014. The DIVERT Scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was an ED visit within six months of a RAI-HC assessment. Results: The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (<1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC =0.617-0.647), two or more ED visits (AUC = 0.628-0.634), and hospital admission (AUC = 0.617-0.664). Conclusions: The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods. Key Words : Home Care, Emergency Department, Geriatrics, DIVERT

scholarly journals The Brighton Spondylodiscitis Score Does Not Accurately Predict the Need for Surgery: A Retrospective Cohort Study in New Zealand

2021 ◽  
pp. 219256822198929
Author(s):  
Sarah Hunter ◽  
Hasanga Fernando ◽  
Joseph F. Baker
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Surgical Intervention ◽  
Predictive Accuracy ◽  
External Validation ◽  
Population Characteristics ◽  
Calibration Plot ◽  
Pyogenic Spondylodiscitis

Study Design: Retrospective cohort study. Objectives: Despite pyogenic spondylodiscitis potentially conferring significant morbidity, there is no consensus on optimal treatment. The Brighton Spondylodiscitis Score (BSDS) was developed to identify patients who would likely fail conservative management and therefore benefit from earlier surgical intervention. In this study, we attempt external validation of the BSDS. Methods: We carried out a retrospective review of all patients treated at our institution, 2010-2016, for pyogenic spondylodiscitis. 91 met inclusion criteria and 40 progressed to require surgical intervention. The BSDS was calculated for each patient allowing stratification into low-, moderate- and high-risk groups. Calibration and discrimination was assessed with ROC curve analysis and calibration plot. Results: Area under the curve (AUC) was 0.469 (0.22-0.71) in our external validation, compared with AUC 0.83 and 0.71 (CI 0.50-0.88) in the original study and test populations respectively. Only 60% of patients in the high-risk group required surgery, 50% in the moderate, and 38% of the low indicating poor calibration and predictive accuracy. Operative intervention was not higher overall in our cohort (44% vs. 32%, p = 0.14). We found greater rates of bacteraemia, more distal infection, and more advanced MRI findings in our cohort. The incidence of spondylodiscitis in our region is higher (4/100 000/year). Conclusion: We failed to externally validate the BSDS in our population which is likely a result of unique population characteristics and the inherently variable pathology associated with spondylodiscitis. Clinicians must be cautious in adopting treatment algorithms developed in other health care systems that may comprise significantly different patient and pathogen characteristics.

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