This retrospective development and held-out validation study used the National Trauma Data Bank (2019–2024) to derive and validate FORD-II, an admission-time clinical score predicting non-home discharge (to inpatient rehab, SNF, LTACH, or intermediate care) in adult fracture-trauma patients, comparing it against three existing scores.
In 650,737 validation encounters (39.9% non-home discharge rate), FORD-II achieved an AUROC of 0.8285—outperforming FORD-I (0.7749), GTOS-II (0.7940), and TRIAGE (0.7446; all P<.001). Observed non-home discharge ranged from 7.29% (low-risk) to 80.47% (high-risk); early discharge planning guided by FORD-II was projected to save $362.25 per patient.
Retrospective registry design using the US National Trauma Data Bank limits generalizability to non-US trauma systems; the budget-impact analysis is exploratory and not empirically validated; the score was not tested prospectively.
Apply FORD-II at admission for adult fracture-trauma patients to flag high-risk individuals (score indicating >80% non-home discharge likelihood) for early case management, rehab assessment, and post-acute placement planning. Non-US centers should await external validation before adopting the tool.
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