Background: With Australia’s aging population and increasing prevalence of chronic, life-limiting conditions, early identification of patients at risk of mortality within 12 months who may benefit from Advance Care Planning is critical. The SPICTTM aids in identifying such patients, but its utility in Australian subacute geriatric settings remains untested. This study evaluates SPICTTM’s ability to identify increased risk of 12-month mortality in this group.
Methods: A quantitative retrospective cohort study analysed electronic medical records and Victorian cemetery databases for patients admitted to subacute geriatric units at two metropolitan Melbourne hospitals. Data comprising demographics, clinical conditions, SPICTTM status at admission and 12-month mortality was collected. Descriptive statistics, parametric and non-parametric statistical assessments were performed using Microsoft Excel.
Results: Data from 215 patients was collected (mean age 83 years, 51% male, mean Charlson Comorbidity Index 7) with 140 patients (65%) identified as SPICTTM +. At 12 months, 53 (25%) patients had died, with SPICTTM + patients showing a significantly higher mortality risk (relative risk 2.3, p=0.005) compared to SPICTTM- patients. SPICTTM demonstrated high sensitivity (0.81) but lower specificity (0.40), with a positive predictive value (PPV) of 0.31 and negative predictive value (NPV) of 0.87.
Conclusion: SPICTTM is a sensitive tool for identifying subacute geriatric patients at increased risk of 12-month mortality, supporting its use as a screening tool in this setting. The high NPV suggests reliability in excluding low-risk patients, while the low specificity indicates a tendency to over-identify at-risk individuals.