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The following is a summary of “A clinical prediction model for safe early discharge of patients with an infection at the emergency department,” published in the January 2025 issue of Emergency Medicine by Mulders et al. 

The rise in hospitalization rates during the COVID-19 pandemic, highlighted the need to recognize patients who do not require hospitalization, as each admission carries healthcare costs and risks of adverse events.   

Researchers conducted a retrospective study to identify predictors of safe early discharge (SED) in patients presenting to the emergency department (ED) with a suspected infection meeting the Systemic Inflammatory Response Syndrome (SIRS) criteria.   

They analyzed adult non-trauma patients with suspected infection and at least 2 SIRS criteria. The SED was defined as discharge within 24 hours (e.g., direct ED discharge or rapid ward discharge) without readmission or death within 7 days. A prediction model for SED was developed using multivariate logistic regression and validated with k-fold cross-validation.   

The results showed that of 1,381 patients, 1,027 (74.4%) were hospitalized for more than 24 hours or readmitted within 7 days, while 354 (25.6%) met the SED criteria. Factors associated with SED included younger age, no comorbidities, independent living, lower triage urgency (yellow or green), no ambulance transport or general practitioner referral, normal clinical impression, and normal vital signs. Risk scores (quick Sequential Organ Failure Assessment (qSOFA), Predisposition Infection Response Organ dysfunction (PIRO), Mortality in Emergency Department Sepsis (MEDS), National Early Warning Score (NEWS), and SIRS) and absence of kidney and respiratory failure were also linked to SED. The model indicated an area under the curve of 0.824, with validation showing minimal performance drop and a good fit.   

Investigators concluded a model was developed and validated to determine patients with infections at the ED who could be discharged safely and early. 

Source: sciencedirect.com/science/article/pii/S0735675724005308