An older patient who has been admitted to the hospital may experience decreased survival after discharge, depending on the severity of his or her underlying conditions. The HELP survival model can be used to estimate the patient's survival and can help identify patients who are at greatest risk. The authors are from 9 institutions in the USA with the lead author from Brown University.
Patients: 80 years of age or older
Parameters:
(1) disease class
(2) age
(3) Glasgow coma score
(4) acute physiologic score (APS) from APACHE III determined on day 3
(5) activities of daily living (ADL), using a modified Katz scale with: eating, continence, toileting, transferring, bathing, dressing and walking
(6) unintended weight loss
|
Parameter |
Finding |
Points |
|
disease class |
acute renal failure, coma or multiorgan system failure |
49 |
|
|
CHF |
35 |
|
|
cancer |
47 |
|
|
orthopedic disorder |
0 |
|
|
all others |
25 |
|
age of the patient |
<=85 |
0 |
|
|
86 - 100 |
(-0.049 * ((age)^2)) + (11.067 * (age)) – 586.39 |
|
|
> 100 |
30.6 |
|
Glasgow coma score |
15 |
0 |
|
|
14 |
6.9 |
|
|
13 |
20 |
|
|
12 |
28 |
|
|
11 |
31.25 |
|
|
8 – 10 |
33.75 |
|
|
7 |
42 |
|
|
6 |
46.75 |
|
|
5 |
68 |
|
|
4 |
71.9 |
|
|
3 |
76.25 |
|
APS |
0 |
0 |
|
|
0 - 70 |
(1.4315 * (APS)) – 0.327 |
|
|
70+ |
100 |
|
ADL |
none dependent |
0 |
|
|
1 dependent |
17.5 |
|
|
2 dependent |
26.25 |
|
|
3 dependent |
30.3 |
|
|
4 dependent |
34 |
|
|
5 dependent |
37.5 |
|
|
6 dependent |
41 |
|
|
7 dependent |
44.38 |
|
unintended weight loss |
none |
0 |
|
|
present |
15 |
from Figure 5, page S23
total points =
= SUM(points for all 6 parameters)
Interpretation:
• minimum total points: 0
• maximum total points: 350+
• The higher the score, the worse the survival.
Using JMP to analyze the survival data in Figure 5, the following relations can be derived:
X for 1 year survival =
= (-0.03493 * (total points)) + 4.3593
probability of 1 year survival =
= 1 / (1 + EXP((-1) * (X)))
Y for 2 year survival =
= (-0.03415 * (total points)) + 3.609
probability of 2 year survival =
= 1 / (1 + EXP((-1) * (Y)))
|
Total Points |
Median Survival in Months |
|
< 72 |
84 |
|
72 – 250 |
(-0.03821 * LN(points)) + 7.18329 |
|
>= 250 |
0.1 |
NOTE: The equation for predicting the median survival gives values that deviate from that given in the nomogram, but they look close enough.
Purpose: To predict survival for an elderly patient admitted to the hospital using the HELP survival model.
Specialty: Sports Medicine & Rehabilitation
Objective: risk factors, severity, prognosis, stage
ICD-10: ,
