Prognosis Links

Here is a listing of many online resources for prognostication near the end-of-life. This post is made after a request from a audience member at a talk I gave recently on Evidence-Based Prognostication. My plan is to update these links and qualify them over the next several weeks. Please feel free to add more in the comments section or email them to me.

The following links are for medical use only (i.e. they are not party tricks!). They should be used as guidelines to help understand the inherent uncertainty of the probability of medical outcomes. Before using any of these tools, you should be familiar with the validation and data sets. Pallimed and Christian Sinclair or his employers are not responsible for any medical outcomes based on these links. Please discuss these results with a medical professional.

Last Update July 9th, 2008
Updates are in bold italics

Cancer

• Advanced Cancer B12-CRP Index via Pallimed
• Breast Adjuvant! Online
• Lung Adjuvant! Online
• Colon Adjuvant! Online
• Paraneoplastic/Complications via EPERC Fast Facts

Congestive Heart Failure

• Seattle Heart Failure Model via University of Washington
• EFFECT (Enhanced Feedback for Effective Cardiac Treatment) via CCORT
  

COPD

• BODE Index via EPERC Fast Facts

Dementia

• Mortality Risk Index or MDS-12 via EPERC Fast Facts

Liver Disease

• MELD Score (Model for End Stage Liver Disease) via Mayo Clinic
• Primary Biliary Cirrhosis via Mayo Clinic

HIV and HAART

• ART Cohort Collaboration
  

Hospice/Palliative Care Patients

• Palliative Performance Scale v2 (Victoria Hospice) in conjunction with the tables found in these two articles:

• Harrold J, Rickerson E, Carroll JT, et al. Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med. Jun 2005;8(3):503-509.

• Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med. Oct 2006;9(5):1066-1075.
  

• Or you can use the Victoria Hospice Prognostat, based on their collective knowledge of PPS scores and survival over the last 10+ years.
  

Victoria Hospice has a number of great prognostic tools on their website as part of the Victoria Palliative Research Network.

Palliative Prognostic (PaP) Score requires evaluation of dyspnea, anorexia, KPS, clinical estimate of survival, total WBC, and lymphocyte percentage. Groups into 3 categories of chance at 30d survival. (Via EPERC Fast Facts)

Palliative Prognostic Index requires PPS, estimate of oral intake, and evaluation of edema, dyspnea, and delirium. See page 4 of this PDF for the scale.

Intensive Care Unit

• APACHE II via SFAR
• SAPS via SFAR
• ProVent Score
  

Renal Patients

• Modified Charlson Comorbidity Score via EPERC Fast Facts
  

Best Book About Medical Prognostication

• Death Foretold: Prophecy and Prognosis in Medical Care by Nicholas Christakis

There may be other prognostic models out there, but I selected the above based on the following criteria:

• Clinically relevant
• Accessible online
• Ease of use

In the future, I plan to add some criteria to these to let you know more about each of these models. Examples of categories to be critiqued include:

• Validated/Studied Populations
• Outcome Relevancy
• Ease of Use
• Limitations
• Unique Factors
• Key Articles Supporting Score/Index

If anyone has an interest in contributing, please let me know (ctsinclair @t gmail d0t com) . Anyone with Microsoft Access expertise or computer/web programming would also be helpful in combining all these things together in a simple website.