How accurate is the terminal prognosis in the minimum data set?
OBJECTIVE
To determine the sensitivity and specificity of terminal prognosis in institutional long-term care (LTC) DESIGN: The Minimum Data Set (MDS 1.0). Data in regard to deaths were collected 6 and 12 months after the assessment.


METHODS
A geriatric hospital responsible for all hospital-based LTC services in one health district (population 71,000) in Helsinki, Finland.


METHODS
All LTC patients (N = 656; 81% female; mean age = 83 years) in treatment during a 1-week period.


RESULTS
One-fourth (n = 164) of the 656 LTC patients had a terminal prognosis. Of these patients, 70.7% survived 6 months, and 58.5% were still alive after 1 year. Consequently, terminal prognosis was associated with a four-fold risk of 6-month mortality. The sensitivity of the terminal prognosis diagnosis was only 29%, whereas the specificity was 89%. The positive predictive accuracy was 47%, but the negative predictive accuracy was 79%.


CONCLUSIONS
Terminal prognosis was clearly overdiagnosed. More information is needed about short-term mortality in terminal prognosis patients and whether this diagnosis affects survival rates.
Finne-Soveri
U H
UH
Helsinki City Hospital, Koskela, Finland.
Tilvis
R S
RS
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005853:Geriatrics; D006782:Hospitals, Special; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity