title: Evaluation of the Palliative Prognostic Score (PaP) and routinely collected clinical data in prognostication of survival for patients referred to a palliative care consultation service in an acute care hospital.
abstract: BACKGROUND
  Patients, caregivers, and clinicians require high levels of information regarding prognosis when conditions are incurable.
  
  
  OBJECTIVE
  1) To validate the Palliative Prognostic Score (PaP) and 2) to evaluate prognostic capacity of used clinical tools and the diagnosis of delirium, in a population referred to a palliative care consultation service at a Canadian acute care hospital.
  
  
  METHODS
  This was a prospective observational cohort study on survival prediction based on the PaP and routinely collected clinical data, including the Palliative Performance Scale (PPS) and the Folstein Mini-Mental State Examination (MMSE). Kaplan-Meier survival curves, log-rank tests for significant differences between survival curves, and the Cox proportional hazards model were used to identify the relationship between the hazard ratio for death and the above variables.
  
  
  RESULTS
  Nine hundred fifty-eight cases underwent final analysis, of which 181 (19%) had a noncancer diagnosis. Median and mean survival were 35 and 131 days, respectively. The three groups, divided based on different ranges of PaP, had significantly different survival curves, with 30-day-survival rates of 78%, 55%, and 11%. Age, PPS, and PaP remained significantly associated with survival, whereas diagnosis group, MMSE, and delirium became insignificant, despite lower hazard of death for cancer vs. noncancer and higher hazard for abnormal vs. normal MMSE and presence vs. absence of delirium.
  
  
  CONCLUSIONS
  The PaP was successfully validated in a population with characteristics that extend beyond those of the population in which it was originally developed. This is the largest sample in which the PaP has been validated to date.
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada. Yoko.Tarumi@albertahealthservices.ca
authors.forename: Yoko
authors.initials: Y
authors.lastname: Tarumi
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Watanabe
authors.forename: Francis
authors.initials: F
authors.lastname: Lau
authors.forename: Ju
authors.initials: J
authors.lastname: Yang
authors.forename: Hue
authors.initials: H
authors.lastname: Quan
authors.forename: Lorelei
authors.initials: L
authors.lastname: Sawchuk
authors.forename: Donna
authors.initials: D
authors.lastname: deMoissac
authors.forename: Gary
authors.initials: G
authors.lastname: Wolch
authors.forename: Vincent
authors.initials: V
authors.lastname: Thai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003693:Delirium / Q000150:complications / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D016019:Survival Analysis; D015996:Survival Rate; D019452:Terminally Ill / Q000706:statistics & numerical data*