Length of stay days Score circle as appropriate 1 2 3 6 4 13 5 4 or more 7 Step 2 Acuity of Admission Was the patient admitted to hospital via the emergency department If yes enter 1473148 in Box A ID: 863359
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\b\b\b\b\t\n \n\n\n\n\f\r\n\t\r\r\t\b\r\f\r\r\t\n\t\n\n\r\f\b\t\n \f\r\b\r\b\n\r\r\n \f\n\b \b\b\r\b\b \r \r\f\r \n\b\b\nStep 1. Length of Stay Length of stay (including day of admission and discharge): _________ days Length of stay (days) Score (circle as appropriate) 1 2 3 -6 4 -13 5 4 or more 7 Step 2. Acuity of Admission Was the patient admitted to hospital via the emergency department? If yes, enter “3” in Box A, otherwise enter “0” in Box A Step 3. Comorbidities Condition (definitions and notes on Score (circle as reverse) appropriate) revious myocardial infarction +1 erebrovascular disease +1 eripheral vascular disease +1 If the TOTAL score is between 0 iabetes without complications +1 and 3 enter the score into Box C. If the score is 4 or higher, enter 5 Step 4. Emergency department visits How many times has the patient visited an emergency department in the six months prior to admission (not including the emergency department visit immediately preceding the current admission)? ___________ Enter this number or 4 (whichever is smaller) in Box E Add numbers in Box L, Box A, Box C, Box E to generate LACE score and enter into box below. I
2 f the A L E LACE &#
f the A L E LACE \b\b\b\b\t\n \n\n\n\n\f\r\n\t\r\r\t\b\r\f\r\r\t\n\t\n\n\r\f\t\n\b\f ondition Definition and/or notes revious myocardial infarction Any previous definite or probable myocardial infarction erebrovascular disease Any previous stroke or transient ischemic attack (TIA) eripheral vascular disease Intermittent claudication, previous surgery or stenting, gangrene or acute ischemia, untreated abdominal or thoracic aortic aneurysm iabetes without microvascular complications No retinopathy, nephropathy or neuropathy ongestive heart failure Any patient with symptomatic CHF whose symptoms have responded to appropriate medications iabetes with end organ damage Diabetes with retinopathy, nephropathy or neuropathy hronic pulmonary disease ?? ld liver disease Cirrhosis but no portal hypertension (i.e., no varices, no ascites) OR chronic hepatitis ny tumor (including lymphoma or leukemia) Solid tumors must have been treated within the last 5 years; includes chronic lymphocytic leukemia (CLL) and polycythemia vera (PV)_ ementia Any cognitive deficit?? onnective tissue disease Systemic lupus erythematosus (SLE), polymyositis, mixed connective tissue disease, moderate to severe rheumatoid arthritis, and polymyalgia rheumatica IDS AIDS-defining opportunistic infection or CD4 200 derate or severe liver disease Cirrhosis with portal hypertension (e.g., ascites or variceal bleeding) tastatic solid tumor Any metastatic tumour