Work

Acute Care for Elders Risk Score: A Practical Machine Learning–Based Tool for Screening High-Risk Older Inpatients

Year: 2025

Type: article

Abstract: OBJECTIVES: To develop and validate a machine learning-based risk score-the Acute Care for Elders (ACE) Risk Score-that integrates the Clinical Frailty Scale (CFS) with readily available clinical and laboratory data to predict adverse outcomes in older hospitalized patients. DESIGN: A retrospective cohort study using a machine learning framework (AutoScore) to develop an interpretable clinical risk score. SETTING AND PARTICIPANTS: This study included 21,757 hospital admissions of patients aged ≥65 years at a tertiary academic hospital between May 2021 and November 2023. The patients were randomly allocated to training (50%), test (45%), and validation (5%) cohorts. METHODS: Eighteen candidate variables were extracted from electronic medical records (EMRs) on the first day of admission. The composite outcome included in-hospital delirium, pressure ulcers, falls, and mortality. Using the AutoScore framework, a parsimonious model with 5 variables (CFS, albumin, C-reactive protein, hemoglobin, and number of pre-admission medications) was selected. Predictive performance was evaluated using receiver operating characteristic analysis and compared with CFS and age. RESULTS: The ACE Risk Score showed superior predictive performance for the composite outcome [area under the curve (AUC) 0.837] compared with CFS alone (AUC 0.798) and age (AUC 0.630; P < .001 for both). Higher ACE scores were also associated with greater risks of safety events, 30-day readmissions and emergency visits after discharge, longer hospital stays, and rapid response team activations. CONCLUSIONS AND IMPLICATIONS: The ACE Risk Score is a practical, interpretable, and scalable tool for early identification of high-risk older inpatients, using data available on the first day of admission. It supports timely, targeted interventions by geriatric teams. The score may facilitate broader implementation of risk-guided care strategies for older adults in hospital settings.

Source: Journal of the American Medical Directors Association

DOI: 10.1016/j.jamda.2025.105818