Table 3

Proposed components of the Criteria for Screening and Triaging to Appropriate aLternative care tool to identify end-of-life status before hospital admission

Age ≥6542638586 AND
Being admitted via emergency this hospitalisation96 (associated with 25% mortality within 1 year)
OR Meets 2 or more of the following deterioration criteria on admission 30 32 98
1. Decreased LOC: Glasgow Coma Score change >2 or AVPU=P or U
2. Systolic blood pressure <90 mm Hg
3. Respiratory rate <5 or >30
4. Pulse rate <40 or >140
5. Need for oxygen therapy or known oxygen saturation <90%33
6. Hypoglycaemia: BGL99
7. Repeat or prolonged seizures99
8. Low urinary output (<15 mL/h or <0.5 mL/kg/h)100
OR MEW or SEWS score >4 46 79
ANDOTHER RISK FACTORS /PREDICTORS OF SHORT-MEDIUM-TERM DEATH
Personal history of active disease (at least one of): 18 25 42 46 63 101 102
 □ Advanced malignancy
 □ Chronic kidney disease
 □ Chronic heart failure
 □ Chronic obstructive pulmonary disease
 □ New cerebrovascular disease
 □ Myocardial infarction
 □ Moderate/severe liver disease
Evidence of cognitive impairment (eg, long term mental disorders, dementia, behavioural alterations or disability from stroke) 25 42 63 73 83
Previous hospitalisation in past year10
Repeat ICU admission at previous hospitalisation95 (associated with a fourfold increase in mortality)
Evidence of frailty: 2 or more of these: 42 46 63 85 89 98
 □ Unintentional or unexplained weight loss (10 lbs in past year)18 83 85
 □ Self-reported exhaustion (felt that everything was an effort or felt could not get going at least 3 days in the past week)85
 □ Weakness (low grip strength for writing or handling small objects, difficulty or inability to lift heavy objects >=4.5Kg)63
 □ Slow walking speed (walks 4.5 m in >7 s)
 □ Inability for physical activity or new inability to stand46 98
Nursing home resident/in supported accommodation33 46
Proteinuria on a spot urine sample: positive marker for chronic kidney disease & predictor of mortality: >30 mg albumin/g creatinine56 103
Abnormal ECG (Atrial fibrillation, tachycardia, any other abnormal rhythm or ≥5 ectopics/min, Changes to Q or ST waves18 42 97
  • ICU, intensive care unit; MEW, modified early warning.