Background: Without objective screening for risk of death, the palliative care needs of older patients near the end of life may be unrecognised and unmet. Aim: This study aimed to estimate the usefulness of the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) tool in determining older patients’ risk of death within 3-months after initial hospital admission. Methods: A prospective cohort study of 235 patients aged 70+ years, who presented to two rural emergency departments in two adjacent Australian states, was utilised. The ‘risk of death’ of each patient was screened with the CriSTAL prognostic tool. Their 3-month follow-up outcomes were assessed through telephone interviews and a clinical record review. Findings: A CriSTAL cut-off score of more than 7 yielded a sensitivity of 80.7% and specificity of 70.81% for a 3-month risk of death. Palliative care services were only used by 31% of the deceased in their last trimester of life. Conclusion: Prognostic tools provide a viable means of identifying individuals with a poor prognosis. Identification can trigger an earlier referral to palliative care, which will benefit the patient's wellbeing and quality of life.


Project published in International Journal of Palliative Nursing February edition (29: 2)

Further to published extract, the following findings will also be discussed:

-Only 2% of survivors who were assessed as prognostically vulnerable were seen by a dedicated palliative care service in the 3 months
-Over 60% of survivors assessed as prognostically vulnerable were assessed as clinically frail (5=+ on Rockwood Clinical Frailty Score)
-Survivors assessed as prognostically vulnerable also self-reported statistically significant poor quality of life when compared to survivors not deemed as prognostically vulnerable (42% compared to 23% respectively P=0.013)
-50% of the deceased had a diagnosis of Advanced Malignancy, while 25% Congestive cardiac failure and 30% COPD.

Discussion points:
-Importance of objective assessment of prognostic vulnerability.
-Poor uptake of palliative care services in inpatient setting for those that are dying and prognostically vulnerable.
-With our focus on early referral and supporting living aspects of life limiting illness (which are noble and just causes), are we missing elements of our core business, which is supporting the dying?  Are we resourced adequately enough to do both?


Pitman, S; Mason, N; Cardona, M; Lewis, E; O'Shea, M; Flood, J; Kirk, M; Seymour, J & Duncan, A 2023; "Triggering palliative care referrals through the identification of poor prognosis in older patients presented to emergency departments in rural Australia", International Journal of Palliative Nursing, 29  (2), https://doi.org/10.12968/ijpn.2023.29.2.83