Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older.

Older people admitted to intensive care are considered to have lower physiological reserves, an increased susceptibility to infection and longer recovery times, resulting in generally poorer outcomes after intensive care treatment. However, biological heterogeneity makes identification of those with the best chances of survival within their group difficult and risks subjecting those at the end of their lives to unsuccessful treatments. There is no fit-for-purpose outcome prediction tool capable of identifying patients most at risk of these poor outcomes at the point of admission to intensive care. This retrospective study sought to identify factors associated with mortality in older patients (≥70 years) admitted to a teaching hospital critical care unit using objective variables readily available at the point of admission. A total of 15 variables were tested for a significant association with mortality. Of these, eight were identified as significant variables (myocardial infarction within 6 months, an abnormal ECG, congestive cardiac failure (NYHA ≥2), chronic pulmonary disease, chronic liver disease, metastatic cancer, a stay in hospital ≥5 days preceding ICU admission, and frailty (Clinical Frailty Score ≥4)). These variables were used from the basis of a novel outcome prediction model. The aim of such a model would be that it could be used at the point of referral to intensive care to inform considerations regarding admission, and to facilitate conversations with the patient and family regarding realistic treatment expectations.