van der Steen Jenny T, Mitchell Susan L, Frijters Dinnus H M, Kruse Robin L, Ribbe Miel W
Department of Nursing Home Medicine, EMGO Institute of the VU University Medical Center, Amsterdam, The Netherlands.
J Am Med Dir Assoc. 2007 Sep;8(7):464-8. doi: 10.1016/j.jamda.2007.05.004. Epub 2007 Aug 13.
Prognostic information is important for guiding palliative care planning for patients with dementia. We aim to validate a risk score that uses Minimum Data Set (MDS) to estimate 6-month mortality for nursing home residents with advanced dementia.
Two cohort studies.
Six nursing homes in The Netherlands, and 35 nursing homes in Missouri.
Long-term stay residents with advanced dementia: 288 Dutch residents and 269 residents from Missouri who also had a lower respiratory tract infection (LRI).
Patient risk factors and 6-month mortality.
Six-month mortality rates were 24.3% for Dutch residents, and 36.8% for US residents. The risk score's AUROC was 0.65 (CI 0.58-0.72), and 0.64 (CI 0.58-0.71), respectively. For the large majority of residents, observed mortality in the 2 validation cohorts were comparable to the development cohort. Among the few residents identified as at very high risk according to the risk score, observed mortality was lower than expected.
The original mortality risk score predicted 6-month mortality with reasonable accuracy in 2 validation cohorts of nursing home residents with advanced dementia. Thus, the performance of the risk score, at least over the range of low to moderate risk (up to around 40% risk of mortality), can be generalized to long-stay (versus recently admitted) residents with advanced dementia, and to those with LRI.
预后信息对于指导痴呆患者的姑息治疗计划至关重要。我们旨在验证一种风险评分，该评分使用最小数据集（MDS）来估计晚期痴呆养老院居民的6个月死亡率。
两项队列研究。
荷兰的六家养老院和密苏里州的35家养老院。
晚期痴呆的长期居住居民：288名荷兰居民和269名来自密苏里州且患有下呼吸道感染（LRI）的居民。
患者风险因素和6个月死亡率。
荷兰居民的6个月死亡率为24.3%，美国居民为36.8%。风险评分的曲线下面积（AUROC）分别为0.65（95%置信区间0.58 - 0.72）和0.64（95%置信区间0.58 - 0.71）。对于绝大多数居民，两个验证队列中的观察到的死亡率与开发队列相当。在根据风险评分被确定为极高风险的少数居民中，观察到的死亡率低于预期。
原始死亡率风险评分在两个晚期痴呆养老院居民验证队列中以合理的准确性预测了6个月死亡率。因此，风险评分的性能，至少在低到中度风险范围内（死亡率风险高达约40%），可以推广到晚期痴呆的长期居住（相对于近期入院）居民以及患有LRI的居民。
