Gait Speed at Discharge and Risk for Readmission or Death: A Prospective Study of an Emergency Ward Population

Abstract

Daniel Hertzberg,1,2 Yauheni Luksha,3,* Ismail Kus,3,* Parto Eslampia,3 John W Pickering,4 Martin J Holzmann1,3 1Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; 2Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; 3Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; 4Department of Medicine, University of Otago Christchurch, and Emergency Department Christchurch Hospital, Christchurch, New Zealand*These authors contributed equally to this workCorrespondence: Daniel HertzbergDepartment of Medicine, Karolinska University Hospital, Solna SE-171 76, Stockholm, SwedenTel [phone] Fax [phone]Email [email protected]: There has been a growing interest in measuring gait speed for assessing long-term mortality and risk for hospital readmission in different populations.Objective: We studied the association between a 10-meter gait speed test at hospital discharge and the risk for 30- and 90-day hospital readmission or death in a mixed population of patients hospitalized for emergency care.Patients and Methods: Patients were prospectively included from 5 wards at the Karolinska University Hospital. The 10-meter gait speed test was measured on the day of discharge. Statistical analysis was performed using logistic regression.Results: A total of  344 patients were included. Forty-one patients (n=41) were readmitted to hospital or died within 30 days, and 81 were readmitted or died within 90 days after discharge. Readmitted patients were older and had more comorbidities. A 0.1 m/s reduction in gait speed was associated with a 13% greater odds of readmission or death within 30 days (OR 1.13 [95% CI 1.00– 1.26]). The area under the receiver operating characteristic curve (AUC) was 0.59 (95% CI  0.51– 0.68). The results were similar for 90-day readmission or death where a 0.1 m/s decrement in gait speed was associated with an OR of 1.13 (95% CI  1.04– 1.24). When age, eGFR, hemoglobin concentration, and active cancer, which all were univariate predictors of 30-day readmissions, were added to the model it yielded an AUC of 0.68 (95% CI  0.60 to 0.77).Conclusion: In a mixed population of patients hospitalized for emergency care, low gait speed at discharge was associated with an increased risk of 30- and 90-day readmission or death. However, the test did not discriminate well between those who were readmitted or died and those who did not; therefore we do not recommend its use as a stand-alone test in this population.Keywords: gait speed, patient readmission, hospitalization

Keywords

• gait speed
• patient readmission
• hospitalization