1. Specialist Palliative Care Team ABM ULHB 6th November 2009
Palliative Prognositic Index - Hospital Palliative Care Team’s Experience
Specialist Palliative Care Team
ABM ULHB
6th November 2009

2. Audit of HPCT Accuracy of Prediction of Survival
Background
Importance achieving preferred priorities of care
Exploration of role in rapid discharge

3. Method First assessment of every patient referred to HPCT over 5 weeks
Prediction of survival
Less than 1 week
Between 1 and 3 weeks
Between 3 and 6 weeks
More than 6 weeks
Date of assessment
Date of death

4. Accuracy of prediction of survival less than 3 weeks
Positive predictive value – of the patients we predicted to survive less than 3 weeks, how many did die within the first 3 weeks
Negative predictive value – of the patients we predicted to survive more than 3 weeks, how many were still alive at 3 weeks
Sensitivity – of all the patients who died within the first 3 weeks, how many had we predicted would survive less than three weeks
Specificity – of all the patients who were alive at 3 weeks, how many had we predicted to survive more than 3 weeks

5. Audit Standard Accuracy of prediction of survival less than 3 week
Positive Predictive Value – 83%
Negative Predictive Value – 65%
Sensitivity – 68%
Specificity – 68%

6. Clinical Prediction of Survival
Results

7. 47 patients Median survival until June 23rd – 21 days
Prediction
Actual survival

8. Survival curve of CPS groups

9. Comparison of CPS and actual survival

10. Accuracy of CPS predicting survival of less than 3 weeks
HPCT
CPS
Standard
PPV 88 83
NPV 63 65
Sensitivity 58 68
Specificity 90
PPI Stone et al
PPI Morita et al
86%
80%
76%
87%
56%
83%
94%
85%    

11. Palliative Prognostic Index
Developed Japan 1999
Assessment of clinical symptoms
No invasive tests
Time scales
Three and six weeks

12. Palliative Prognostic Index
Items
Palliative Performance Scale
Oral intake
Oedema
Dyspnoea at rest
Delirium
Scores
4, 2.5, 0
2.5, 1, 0
1, 0
3.5, 0
4, 0
PPI total score >6 = suggests survival of less than 3 weeks

13. CPS and PPI results

14. Comparison of patient survival between the two cycles

15. 50 patients
Predicted survival
Actual survival

16. Survival of the two groups

17. CPS and PPI prediction of survival of less than 3 weeks

18. Accuracy of CPS + PPI     PPV 68 83 Sensitivity 76 HPCT CPS
Standard
PPV 68 83
NPV 73 65
Sensitivity 76
Specificity 94    

19. Conclusion
The HPCT will not routinely use the Palliative Prognostic Index to estimate patient survival

20. Thank you