Author Affiliations: Departments of Medicine and Health Administration, University of Toronto, Toronto, Ontario.
Prognostic indices are used extensively in clinical research and health
service quality reviews to adjust for patients' severity of illness. Given
their ubiquitous use in clinical studies, it seems surprising that prognostic
indices are rarely used in clinical practice. Such disregard seems to persist
even if a prognostic index addresses an important outcome, is derived by rigorous
methods, and appears in a prestigious journal. Consider the article by Walter
et al1 in this issue of THE JOURNAL that reports
that older patients hospitalized on a general medical service have about a
one-third risk of dying in the year following discharge. The 6 characteristics
that can be used to predict a patient's specific risk are male sex, dependence
in activities of daily living, cancer, heart failure, renal insufficiency,
Redelmeier DA, Lustig AJ. Prognostic Indices in Clinical Practice. JAMA. 2001;285(23):3024–3025. doi:10.1001/jama.285.23.3024
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