hospice guidelines for determining prognosis, stroke & coma

Guidelines: 1) poor prognostic signs immediately following hemorrhagic or ischemic stroke a) coma or persistent vegetative state, beyond 3 days duration b) in post-anoxic stroke, coma or severe obtundation, accompanied by myoclonus, persisting 3 days after the anoxic event c) comatose patients with 4/5 of the following on day 3 of coma had 97% mortality in 2 months 1] abnormal brain stem response 2] absent verbal response 3] absent withdrawal response to pain 4] serum creatinine > 1.5 mg/dL 5] age > 70 years d) dysphagia severe enough to prevent sufficient oral intake of food & fluids to sustain life, in a patient who declines, or is not a candidate for artificial nutrition & hydration e) diagnostic imaging factors 2) poor prognostic factors in the chronic phase a) age > 70 b) poor functional status; Karnofsky score < 50 c) post-stroke dementia; FAST score > 7 d) poor nutritional status 1] unintentional weight loss > 10% in past 6 months 2] serum albumin < 2.5 mg/dL e) medical complications related to debility 1] aspiration pneumonia 2] upper urinary tract infection (pyelonephritis) 3] sepsis 4] refractory stage 3 & 4 pressure ulcer 5] recurrent fever after antibiotic therapy

References

Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996