DNAR IN GERY MED

Proposed components of the Criteria for Screening and Triaging to Appropriate aLternative care tool to identify end-of-life status after a rapid response call where a do-not-resuscitate order is not in place

□	Age ≥6542638586
□	AND admitted via emergency this hospitalisation96 (associated with 25% mortality within 1 year)
□	OR met 2 or more of the selected MET calling criteria below30 32 98
□	1-Decreased LOC: Glasgow Coma Score change >2 or AVPU=P or U
□	2-Systolic blood pressure <90 hg="" mm="" td="">
□	3-Respiratory rate <5 or="">30
□	4-Pulse rate <40 or="">140
□	5-Need for oxygen therapy or known oxygen saturation <90 class="xref-bibr" id="xref-ref-33-5" span="" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-size: 1.2rem; font-weight: bolder; line-height: 1.4em; vertical-align: 0.6rem;">33

□6-Hypoglycaemia: BGL99 □7-Repeat or prolonged seizures99 □8-Low urinary output (<15 class="xref-bibr" h="" id="xref-ref-100-2" kg="" ml="" or="" span="" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-size: 1.2rem; font-weight: bolder; line-height: 1.4em; vertical-align: 0.6rem;">100 □OR MEW or SEWS score >446 79 ANDOTHER RISK FACTORS /PREDICTORS OF SHORT-MEDIUM-TERM DEATH □Personal history of active disease (at least one of):18 25 42 46 63 96 101  □ Advanced malignancy  □ Chronic kidney disease  □ Chronic heart failure,  □ Chronic obstructive pulmonary disease  □ New cerebrovascular disease  □ Myocardial infarction  □ Moderate/severe liver disease □Evidence of cognitive impairment (eg, long-term mental disorders, dementia, behavioural alterations or disability from stroke)25 42 63 73 83 96 □Length of stay before this RRT call (>5 days predicts 1-year mortality)46 96 □
□Previous hospitalisation in past year10
repeat ICU admission at this or previous hospitalisation95 (associated with a fourfold increase in mortality) □Evidence of frailty: 2 or more of these: 42 46 63 85 89 98  □ Unintentional or unexplained weight loss (10 lbs in past year)18 83 85  □ Self-reported exhaustion (felt that everything was an effort or felt could not get going at least 3 days in the past week)85  □ Weakness (low grip strength for writing or handling small objects, difficulty or inability to lift heavy objects ≥4.5 kg)63  □ Slow walking speed (walks 4.5 m in >7 s)  □ Inability for physical activity or new inability to stand46 98 □Nursing home resident/in supported accommodation33 46 96 □Proteinuria on a spot urine sample: positive marker for chronic kidney disease & predictor of mortality: >30 mg albumin/g creatinine56 103 □Abnormal ECG (Atrial fibrillation, tachycardia, any other abnormal rhythm or ≥5 ectopics/min, Changes to Q or ST waves18 42 97

• MET, medical emergency team; MEW, modified early warning; RRT, rapid response team.