To be more precise, the evaluation tool, officially named “Criteria for Screening and Triaging to Appropriate Alternative Care (CrisTAL), is a screening checklist designed to help doctors identify elderly frail people at risk of death within 90 days. The death test was developed by researchers at Sydney, Australia’s Simpson Centre for Health Services Research at the University of New South Wales. The CrisTAL evaluation checklist was compiled as a result of research lead by Dr. Magnolia Cardona-Morrell. The study findings were published in the journal BMJ Supportive & Palliative Care. According to Cardona-Morrell, CriSTAL was devised to improve doctors’ confidence in the prognosis so they can tell patients the truth about their prognosis. While referred to as a death test in the popular press (and in this article), Dr. Cardona-Morrell believes it would be much more accurate to refer to the tool as the “end-of-life checklist” or the “end-of-life decision-making tool.”
A test to identify those elderly patients most at risk of dying within 90 days has been developed by doctors.
They say the test will give people the chance to go home and spend time saying goodbye to loved ones, preventing them from enduring their last days in hospital.
The 29-point checklist will prevent futile and costly treatments that prolong the patient’s suffering and frustrate doctors, the researchers said.
The test comprises a checklist of 29 predictors of health including age, frailty, the severity of their illness and mental impairment.
Read the full story: The 29-point DEATH test
To come up with the death test, Dr. Cardona-Morrell and her team studied relevant articles and scholarly papers. These papers addressed issues such as the definition of dying, preferred place of death, and the likelihood of options for end-of-life care. Based on their research the team came up with the death test criteria. Based on these criteria doctors should be able to assess the probability that a patient will recover and use this as the basis for a discussion of the patient’s options. The end-of-life checklist is still under refinement and further research is needed to test the test and caregivers will require training in its application. This article was updated on February 2, 2015
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Death Test Criteria (from dailymail.com)
For patients with an age of 65 or over who have been admitted to hospital this time in an emergency: 1. Altered level of consciousness (Glasgow Coma Score change >2 or AVPU=P or U) 2. Blood pressure (systolic blood pressure of less than 90 mm Hg) 3. Respiratory rate of more than five and less than 30 4. Pulse rate of less than 40 or more than 140 5. Need for oxygen therapy, or known oxygen saturation of less than 90 percent 6. Hypoglycemia blood glucose level (less sugar in the blood than normal) 7. Repeat or prolonged seizures 8. The low output of urine (less than 15 mL/h or less than 0.5 mL/kg/h) or a MEW or SEWS score of more than 4 9. Previous history of the disease, including 10. Advanced cancer 11. Kidney disease 12. Heart failure 13. Various types of lung disease 14. Strokes and vascular dementia 15. Heart attack 16. Moderate to severe liver disease 17. Mental impairment such as dementia or disability from a stroke 18. Length of stay before this RRT call (>5 days predicts 1-year mortality) 19. Repeat hospitalizations in the past year 20. Repeat admission to the intensive care department of the hospital 21. Frailty 22. Unexplained weight loss 23. Self-reported exhaustion 24. Weakness (being unable to grip objects, being unable to handle objects or lift heavy objects of less than or equal to 4.5kg, 25. Slow walking speed (walks 4.5m in more than 7 seconds) or is 26. Inability to do physical exercise or stand 27. Is a nursing home resident or lives in supported accommodation 28. Having urine in their blood (more than 30mg albumin/g creatinine 29. Abnormal ECG (irregular heartbeat, fast heartbeat, and any other abnormal rhythm or more than or equal to 5 ectopics/min and changes to Q or ST waves) Read the full study as published in BMJ Supportive & Palliative Care.