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Multicentre, prospective observational study of the correlation between the Glasgow Admission Prediction Score and adverse outcomes
  1. Dominic Jones1,
  2. Allan Cameron2,
  3. David J Lowe3,
  4. Suzanne M Mason1,
  5. Colin A O'Keeffe1,
  6. Eilidh Logan4
  1. 1 School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2 Acute Medicine, Glasgow Royal Infirmary, Glasgow, UK
  3. 3 Emergency Department, Queen Elizabeth University Hospital Campus, Glasgow, UK
  4. 4 University of Glasgow School of Life Sciences, Glasgow, UK
  1. Correspondence to Dr Dominic Jones; jones.dom17{at}gmail.com

Abstract

Objectives To assess whether the Glasgow Admission Prediction Score (GAPS) is correlated with hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. This study represents a 6-month follow-up of patients who were included in an external validation of the GAPS’ ability to predict admission at the point of triage.

Setting Sampling was conducted between February and May 2016 at two separate emergency departments (EDs) in Sheffield and Glasgow.

Participants Data were collected prospectively at triage for consecutive adult patients who presented to the ED within sampling times. Any patients who avoided formal triage were excluded from the study. In total, 1420 patients were recruited.

Primary outcomes GAPS was calculated following triage and did not influence patient management. Length of hospital stay, hospital readmission and mortality against GAPS were modelled using survival analysis at 6 months.

Results Of the 1420 patients recruited, 39.6% of these patients were initially admitted to hospital. At 6 months, 30.6% of patients had been readmitted and 5.6% of patients had died. For those admitted at first presentation, the chance of being discharged fell by 4.3% (95% CI 3.2% to 5.3%) per GAPS point increase. Cox regression indicated a 9.2% (95% CI 7.3% to 11.1%) increase in the chance of 6-month hospital readmission per point increase in GAPS. An association between GAPS and 6-month mortality was demonstrated, with a hazard increase of 9.0% (95% CI 6.9% to 11.2%) for every point increase in GAPS.

Conclusion A higher GAPS is associated with increased hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. While GAPS’s primary application may be to predict admission and support clinical decision making, GAPS may provide valuable insight into inpatient resource allocation and bed planning.

  • accident & emergency medicine
  • organisation of health services
  • organisational development

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors DJ, AC, DJL, SMM, CAOK and EL contributed to the design of the study. EL and DJ collected and recorded the data. DJ wrote the manuscript with significant input from AC, DL, SMM, CAOK and EL during each revision.

  • Funding Three of the authors of this paper (DJ, CAOK and SMM) were supported by the NIHR Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). www.clahrc-yh.nihr.ac.uk. The views and opinions expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The advice of the West of Scotland Research Ethics committee was sought, and it was advised that this study should be considered a service evaluation. Approval was also given by the local Caldicott Guardian in Glasgow and Sheffield.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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