Cardona-Morrell and Hillman reported a tool for identifying a dying patient in the hospital who may die in the next few months. Such a patient may benefit from palliative care. The authors are from the University of New South Wales and Liverpool Hospital in Australia.
CriSTAL = Criteria for Screening and Triaging to Appropriate Alternative Care
Criteria - all of the following:
(1) age >= 65 years
(2) core risk factors
(3) predictors of short-to-medium term death
Core risk factors - one or more of the following:
(1) hospital admission from the Emergency Department
(2) >= 2 of the following
(2a) decreased level of consciousness (AVPU P or U; delta GCS >2)
(2b) systolic blood pressure < 90 mm Hg
(2c) respiratory rate < 5 or > 30 breaths per minute
(2d) heart rate < 40 or > 140 beats per minute
(2e) need for oxygen therapy OR oxygen saturation < 90%
(2f) hypoglycemia
(2g) repeated or prolonged seizures
(2h) urine output < 0.5 mL per kg per hour
(3) MEW or SEWS > 4
Predictors of short-to-medium term death:
(1) personal history of active disease (advanced malignancy, chronic kidney disease, chronic heart failure, chronic obstructive pulmonary disease, new cerebrovascular disease, myocardial infarction, moderate or severe liver disease)
(2) cognitive impairment
(3) previous hospitalization in the past year
(4) repeat ICU admission in previous hospitalization
(5) evidence of frailty (see below)
(6) nursing home residence or supported accommodation
(7) proteinuria on spot urine OR urine albumin to creatinine ratio > 30 mg/g)
(8) one or more of these ECG changes (atrial fibrillation, tachycardia, other abnormal rhythm, change to Q wave, change to ST wave, >= 5 ectopic beats per minute)
Evidence of frailty - >= 2 of the following:
(1) unintended weight loss (>= 4.5 kg in past year)
(2) weakness (low grip strength; unable to lift object >= 4.5 kg)
(3) slow walking speed (>= 7 seconds to walk 4.5 meters)
(4) inability for physical activity OR new inability to stand
