Retrospective Chart Review: Readmission Prediction Ability of the High Acuity Readmission Risk Pediatric Screen (HARRPS) Tool.

Background: Nurse Case Managers utilize adult based readmission risk tools upon admission to identify readmission risk. An evidence-based pediatric readmission tool could not be identified to replicate in the pediatric space, therefore the High Acuity Readmission Risk Pediatric Screen (HARRPS) Tool was developed to fill this gap. The research aim was to develop a risk score algorithm that accurately predicts pediatric readmissions and provide a predictive validation of the HARRPS Tool.

Method: This was a single-centered, retrospective chart review study which compared pediatric patients with thirty-day readmissions to those without thirty-day readmissions over a twelve-month period. Sample size ratio of 1:2 was determined via power analysis with an overall sample size of 5371. Each category from the HARRPS Tool was appropriately weighted based upon data from this study to then produce an overall, patient-level risk score, which was summed [allowable range: 0, 14] across all components. Cross validation was used to ascertain the readmission risk predictability.

Results: Of the 5306 patients included in the final analysis, 1343 (25.3%) had a thirty-day readmission. Out of nine risk components analyzed, eight were consistent with the literature review findings. Patients with a score of seven or higher had a 54.9% predicted probability of a thirty-day readmission, compared to 13.6% for patients with a risk score of zero. The c-statistic score of the HARRPS Tool was determined to be 0.68 [95% CI, 0.67, 0.69]. Overall, the HARRPS Tool was favorable and provides initial credibility of the tool's predictive power for the general pediatric population.