The researchers developed a 29-point "death test" to identify patients at highest risk of dying within 90 days, according to a report in the BMJ of Supportive and Palliative Care. Dubbed CriSTAL – for Criteria for Screening and Triaging to Appropriate aLternative care – the test includes the patient's age, frailty, weight loss, protein in the urine, severity of illness, mental impairment, altered level of consciousness and abnormal pulse, respiratory rate and blood pressure.
The combination of these measures, from multiple screening tools, achieved a higher predictive rate for death than any of the individual tests from which they were drawn.
The researchers are quick to point out that CriSTAL needs extensive additional validation testing before it could be recommended for routine use. And, importantly, the tool is not intended to deny terminal elderly patients access to healthcare; rather, it will provide an objective assessment of the dying patient as a starting point to talk honestly with patients and their families about appropriate care.
And such is the slippery slope identified by the Australian researchers: a predictive tool for death could also be used to ration care, rather than for promoting humanitarian decisions. That said, this type of research remains an important cornerstone for improving medical decision-making. Predictive information that informs doctor, patients and family about the likelihood of death can be very useful, provided it does not compel those parties to violate their medical and personal choices.
Source: http://ift.tt/1yFC3wR
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