title: PREDICT: a diagnostic accuracy study of a tool for predicting mortality within one year: who should have an advance healthcare directive?
abstract: BACKGROUND
  CARING is a screening tool developed to identify patients who have a high likelihood of death in 1 year.
  
  
  OBJECTIVE
  This study sought to validate a modified CARING tool (termed PREDICT) using a population of patients presenting to the Emergency Department.
  
  
  METHODS
  In total, 1000 patients aged over 55 years who were admitted to hospital via the Emergency Department between January and June 2009 were eligible for inclusion in this study.
  
  
  METHODS
  Data on the six prognostic indicators comprising PREDICT were obtained retrospectively from patient records. One-year mortality data were obtained from the State Death Registry. Weights were applied to each PREDICT criterion, and its final score ranged from 0 to 44. Receiver operator characteristic analyses and diagnostic accuracy statistics were used to assess the accuracy of PREDICT in identifying 1-year mortality.
  
  
  RESULTS
  The sample comprised 976 patients with a median (interquartile range) age of 71 years (62-81 years) and a 1-year mortality of 23.4%. In total, 50% had ≥1 PREDICT criteria with a 1-year mortality of 40.4%. Receiver operator characteristic analysis gave an area under the curve of 0.86 (95% confidence interval: 0.83-0.89). Using a cut-off of 13 points, PREDICT had a 95.3% (95% confidence interval: 93.6-96.6) specificity and 53.9% (95% confidence interval: 47.5-60.3) sensitivity for predicting 1-year mortality. PREDICT was simpler than the CARING criteria and identified 158 patients per 1000 admitted who could benefit from advance care planning.
  
  
  CONCLUSIONS
  PREDICT was successfully applied to the Australian healthcare system with findings similar to the original CARING study conducted in the United States. This tool could improve end-of-life care by identifying who should have advance care planning or an advance healthcare directive.
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia School of Medicine, The University of Queensland, Brisbane, QLD, Australia philip_richardson@health.qld.gov.au.
authors: Philip
authors: P
authors: Richardson
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia School of Medicine, The University of Queensland, Brisbane, QLD, Australia School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia.
authors: Jaimi
authors: J
authors: Greenslade
authors: School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors: Sulochana
authors: S
authors: Shanmugathasan
authors: School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors: Katherine
authors: K
authors: Doucet
authors: School of Medicine, The University of Queensland, Brisbane, QLD, Australia Intensive Care Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Neil
authors: N
authors: Widdicombe
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors: Kevin
authors: K
authors: Chu
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors: Anthony
authors: A
authors: Brown
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies
keywords: Emergency medicine; advance care planning; end of life care; palliative care