O'Callaghan Anne, Laking George, Frey Rosemary, Robinson Jackie, Gott Merryn
Palliative Care, Auckland City Hospital, Auckland, New Zealand Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand Oncology, Auckland City Hospital, Auckland, New Zealand.
Palliat Med. 2014 Sep;28(8):1046-52. doi: 10.1177/0269216314536089. Epub 2014 May 22.
Screening to identify hospital inpatients with a short life expectancy may be a way to improve care towards the end of life. The Gold Standards Framework Prognostic Indicator Guidance is a screening tool that has recently been advocated for use in the hospital setting.
To assess the clinical utility of the Gold Standards Framework Prognostic Indicator Guidance as a screening tool in an acute hospital setting.
Mortality at 6 and 12 months and sensitivity, specificity and predictive value of the Gold Standards Framework Prognostic Indicator Guidance at 1 year.
DESIGN, SETTING AND PARTICIPANTS: Prospective cross-sectional study of 501 adult inpatients in a tertiary New Zealand teaching hospital screened utilising the Gold Standards Framework Prognostic Indicator Guidance.
A total of 99 patients were identified as meeting at least one of the Gold Standards Framework Prognostic Indicator Guidance triggers. In this group, 6-month mortality was 56.6% and 12-month mortality was 67.7% compared with 5.2% and 10%, respectively, for those not identified as meeting the criteria. The sensitivity and specificity of the Gold Standards Framework Prognostic Indicator Guidance at 1 year were 62.6% and 91.9%, respectively, with a positive predictive value of 67.7% and a negative predictive value of 90.0%.
The sensitivity, specificity and predictive values of the Gold Standards Framework Prognostic Indicator Guidance in this study are comparable to, or better than, results of studies identifying patients with a limited life expectancy in particular disease states (e.g. heart failure and renal failure). Screening utilising the Gold Standards Framework Prognostic Indicator Guidance in the acute setting could be the first step towards implementing a more systematic way of addressing patient need--both current unrecognised and future anticipated--thereby improving outcomes for this population.
筛查以确定预期寿命较短的住院患者可能是改善临终护理的一种方式。金标准框架预后指标指南是一种筛查工具，最近有人主张在医院环境中使用。
评估金标准框架预后指标指南作为急性医院环境中筛查工具的临床效用。
6个月和12个月时的死亡率以及金标准框架预后指标指南在1年时的敏感性、特异性和预测价值。
设计、设置和参与者：对新西兰一家三级教学医院的501名成年住院患者进行前瞻性横断面研究，使用金标准框架预后指标指南进行筛查。
共有99名患者被确定至少符合金标准框架预后指标指南的一项触发标准。在这组患者中，6个月死亡率为56.6%，12个月死亡率为67.7%，而未被确定符合标准的患者分别为5.2%和10%。金标准框架预后指标指南在1年时的敏感性和特异性分别为62.6%和91.9%，阳性预测值为67.7%，阴性预测值为90.0%。
本研究中金标准框架预后指标指南的敏感性、特异性和预测价值与识别特定疾病状态（如心力衰竭和肾衰竭）中预期寿命有限患者的研究结果相当或更好。在急性环境中使用金标准框架预后指标指南进行筛查可能是朝着实施更系统的方式来满足患者当前未被认识和未来预期需求迈出的第一步，从而改善这一人群的结局。
