Insufficient Evidence to Recommend Prognostic Indices

Indices for predicting mortality in older adults have potential bias; need independent validation

WEDNESDAY, Jan. 11 (HealthDay News) -- There is insufficient evidence to recommend the widespread clinical use of validated prognostic indices to predict the risk of mortality in older adults, according to a review published in the Jan. 11 issue of the Journal of the American Medical Association.

Lindsey C. Yourman, M.D., of the University of California in San Francisco, and colleagues investigated the quality and limitations of prognostic indices for mortality for older adults. They conducted a systematic review of validated indices that predicted the absolute risk of mortality in patients with an average age of 60 years or older. Indices that estimated intensive care unit, disease-specific, or in-hospital mortality were excluded.

The researchers identified 16 indices that predicted the risk of mortality from six months to five years for older adults in different clinical settings: in the community (six indices), in nursing homes (two indices), and in hospitals (eight indices). In all but three indices, at least one measure of transportability was tested. The researchers found that no study was free from potential bias. Although 13 indices had C statistics ≥0.70, none had C statistics of ≥0.90. Independent validation by researchers not involved in the index's development was seen for only two indices.

"We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended," the authors write.

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