hospice guidelines for determining prognosis, stroke & coma

Introduction

Guidelines:

• poor prognostic signs immediately following hemorrhagic or ischemic stroke
  • coma or persistent vegetative state, beyond 3 days duration
  • in post-anoxic stroke, coma or severe obtundation, accompanied by myoclonus, persisting 3 days after the anoxic event
  • comatose patients with 4/5 of the following on day 3 of coma had 97% mortality in 2 months
    • abnormal brain stem response
    • absent verbal response
    • absent withdrawal response to pain
    • serum creatinine > 1.5 mg/dL
    • age > 70 years
  • 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
  • diagnostic imaging factors
• poor prognostic factors in the chronic phase
  • age > 70
  • poor functional status; Karnofsky score < 50
  • post-stroke dementia; FAST score > 7
  • poor nutritional status
    • unintentional weight loss > 10% in past 6 months
    • serum albumin < 2.5 mg/dL
  • medical complications related to debility
    • aspiration pneumonia
    • upper urinary tract infection (pyelonephritis)
    • sepsis
    • refractory stage 3 & 4 pressure ulcer
    • recurrent fever after antibiotic therapy

More general terms

• hospice guidelines for determining prognosis