Trajectory 3 cases (n=18)Trajectory 4 cases (n=9)
Age (median, range)80.5 (38-88) yearsAge (median,
range)
86 (63–91) years
Gender12 female; 6 maleGender4 female; 5 male
CACI Comorbidity Score
(median, range)
6 (1-12)CACI Comorbidity Score
(median, range)
8 (5–14)
Social historyCare/nursing home
resident or respite
1Social historyCare/nursing home resident or respite5
Home carers4Home carers1
Length of admission
(median, range)
17.5 (3-97) daysLength of admission
(median, range)
12 (2–28) days
Primary reason for
admission
Gastrointestinal3Primary reason for
admission
Sepsis3
Cerebrovascular accident2Respiratory tract infection2
Respiratory tract infection5Malignancy1
Urinary tract infection1Cerebrovascular accident1
Specialist treatment
(chemotherapy, cardio ablation)
2Fall1
Haematological1Acute heart failure1
Fracture1
General decline + hypertension2
Respiratory1
Received CCO/ITU review4Pre-existing factors for
characterising admission
Some cases had more than
one factor*
Frailty5
History of recent deterioration2
Pre-existing DNACPR**4
Current malignancy3
Underlying dementia3
Already known to palliative care3
Received HDU/ITU careIntensive care unit3Prompts for setting early
treatment limits
Some cases had more
than one prompt*
Senior clinician review7
Patient’s prior wishes expressed by family4
Discussion with patient3
Marked deterioration4
Significant point triggering
de-escalation
Some cases has more than
one more trigger*
Significant deterioration
in current condition
6
New diagnosis leading
to deterioration in condition
11
New clinical team/out of hours input
recognising
poor prognosis
4
  • *Charlson Age Comorbidity Index (CACI; www.pmidcalc.org/7722560) (Charlson et al 20).

  • †One individual lived for 16 days despite catastrophic event due to younger age.

  • ‡Critical care outreach/intensive care review.

  • §High dependency/intensive care.

  • ¶Cardiopulmonary resuscitation.

  • **Do not attempt cardiopulmonary resuscitation.

  • HDU, high dependency unit; ICU, intensive care unit.