Luethi et al reported the electronic Poor Outcome Screening (ePOS) score for evaluating critically ill patients. This can help to identify a patient who may benefit from palliative care. The authors are from University of Bern, and Kantonsspital Aurau in Switzerland.
Patient selection: ICU patient
Parameters:
(1) age in years
(2) functional status
(3) active malignancy
(4) number of previous hospital admissions within the past 6 months
(5) time between hospital and ICU admissions
(6) ICU admission type
(7) ICU admission diagnosis
(8) serum lactate in mmol/L at 48 hours after ICU admission
(9) invasive mechanical ventilation at 48 hours after ICU admission
(10) vasoactive drugs at 48 hours after ICU admission
(11) renal replacement therapy at 48 hours after admission
|
Parameter
|
Finding
|
Points
|
|
age in years
|
< 60 years
|
0
|
|
|
60 to 69 years
|
5
|
|
|
70 to 79 years
|
9
|
|
|
>= 80 years
|
14
|
|
functional status
|
independent
|
0
|
|
|
partially dependent
|
3
|
|
|
fully dependent
|
3
|
|
active malignancy
|
no
|
0
|
|
|
yes
|
3
|
|
hospital admissions
|
0
|
0
|
|
|
1 or 2
|
2
|
|
|
>= 3
|
5
|
|
time between admissions
|
< 24 hours
|
0
|
|
|
>= 24 hours
|
11
|
|
admission time
|
surgical
|
0
|
|
|
medical
|
4
|
|
admission diagnosis
|
cardiovascular disease
|
2
|
|
|
respiratory failure
|
2
|
|
|
non-traumatic cerebral pathology
|
7
|
|
|
cardiac arrest
|
7
|
|
|
other
|
0
|
|
serum lactate
|
<= 2 mmol/L
|
0
|
|
|
> 2 mmol/L
|
9
|
|
invasive mechanical ventilation
|
no
|
0
|
|
|
yes
|
9
|
|
vasoactive drugs
|
no
|
0
|
|
|
ye
|
2
|
|
renal replacement therapy
|
no
|
0
|
|
|
yes
|
5
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 72 (the paper says 46, which may have been the maximum seen in the study population)
• A score >= 20 is associated with 6-month mortality with sensitivity of 0.81 and specificity of 0.51.
Performance:
• The area under the ROC curve is 0.72.
