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June 20, 2001

Prognostic Indices in Clinical Practice

Author Affiliations

Author Affiliations: Departments of Medicine and Health Administration, University of Toronto, Toronto, Ontario.

JAMA. 2001;285(23):3024-3025. doi:10.1001/jama.285.23.3024

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, and hypoalbuminemia.