LACE Index for Readmission

LACE Calculator
L – Length of Stay (days)
A – Acuity of Admission
C – Charlson Comorbidity Index
E – ED Visits in Past 6 Months
LACE Index: 0
Predicts 30-day readmission or death in patients on medicine and surgery wards.

Why Use

Can identify patients that might benefit from post-discharge nursing care. Predicts rates of readmission, with some studies identifying the number of ED visits in 6 months which is a component of the LACE as the major predictor of readmission. Has similar discriminating ability as other scores such as the HOSPITAL score and 8Ps.

When to Use

Adult patients admitted to medical or surgical wards.

Formula

Attribute Value Points L: Length of stay (days) <1 1 2 3 4-6 7-13 ≥14 0 1 2 3 4 5 7 A: Acute (emergent) admission Yes No 3 0 C: Charlson Comorbidity Index 0 1 2 3 ≥4 0 1 2 3 5 E: Visits to emergency department during previous 6 months (not including ED visit of current admission) 1 2 3 ≥4 1 2 3 4 In this study, Charlson Comorbidity Index was calculated by adding points as follows: 1 point History of myocardial infarction. Peripheral vascular disease. Cerebrovascular disease. Diabetes without complications. 2 points Congestive heart failure. Chronic obstructive pulmonary disease. Mild liver disease or cancer. 3 points Dementia. Connective tissue disease. 4 points Moderate to severe liver disease. HIV infection. 6 points Metastatic cancer. From Walraven et al 2010 .

Pearls / Pitfalls

Length of stay cannot be factored in until day of discharge, thus limiting real-time use. Note that mean age of study participants was 61 years in the derivation LACE study. Validated for use in congestive heart failure patients. The LACE was externally validated in 1,000,000 Ontarians in the original publication , and has since been tested in several external populations ( Spiva 2016 , Low 2016 , Low 2017 , Shaffer 2019 ). A more detailed version of LACE ( LACE+ ) has been created with increased discrimination. A modified version of the Charlson Comorbidity Index, excluding age, was used based on Schneeweiss 2003 .

Advice

Consider post discharge visits for medication reconciliation and adherence check in heart failure patients with higher LACE scores.

More Information

Score interpretation: LACE Index Score Risk 0-4 points Low 5-9 points Moderate >9 points High

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