Patients will be considered to be in the terminal stage of stroke (CVA) or coma if they meet the following criteria.
Criteria 1 and 2 are important indicators of functional and nutritional status and will support a terminal prognosis for patients with diagnosis of stroke. Number 3 will lend support.
1. Poor functional status with a Palliative Performance Scale (PPS) (PDF, 120 KB) of 40 or less. All criteria in number 1 should be met:
- Mainly bed-bound
- Unable to work
- Requires maximal assistance to perform self-care
- Food/fluid intake are normal/reduced
- Either fully conscious or drowsy/confused
- Weight loss >10% during previous 6 months
- Weight loss > 7.5% in previous 3 months
- Serum albumin
- Current history of pulmonary aspiration without effective response to speech language pathology interventions to improve dysphagia and decrease aspiration events.
- Calorie counts documenting inadequate caloric/fluid intake.
- Dysphagia severe enough to prevent the patient from receiving food/fluid that is necessary to sustain life in a patient who does not receive artificial nutrition/hydration.
- Recurrent or intractable infections such as pneumonia or other URI
- Urinary tract infection
- Refractory stage 3-4 decubitus ulcers
- Fever recurrent after antibiotics
The medical criteria listed below would support a terminal prognosis for individuals with a diagnosis of coma (any etiology). Comatose patients with any three of the following on day three of coma are considered terminal:
- Abnormal brain stem response
- Absent verbal response
- Absent withdrawal response to pain
- Serum creatinine >1.5 mg/dl
If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact a local Compassus program for information.