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The [SIMPLE] Tools Doctors Can Use to Predict Your Health Outcomes
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Apr 30, 2025
Many times, older adults with cancer ask their doctors about estimates for their life expectancy, likelihood of surviving surgery, and remaining independent. Then they say, "We know that you don't have crystal balls". While doctors don't have crystal balls. They do use and can use some risk calculators to assess patient outcomes. There are more than a hundred clacultors available for various health-related situations. Some are sophisticated and difficult for patients to understand, while others are easier to use and comprehend by patients and their families. In part 1 of this series, we will review Karnofsky Performance Scale, Activities of Daily Living, Charlson Comorbidity Index, and POSSUM. #cancer #olderpeople #geriatriconcology #arminshahrokni #healthrisk #elderly #karnofsky #ADL #charlson #POSSUM #surgery #lifeexpectancy
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0:00
everyone and welcome back to the channel
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Let me ask you something Have you ever
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been in a situation maybe facing surgery
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dealing with a health condition or just
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thinking about the future and wish you
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had a crystal ball the little peak into
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what might happen Of course real crystal
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balls don't exist But what if I told you
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that doctors do have tools powered by
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data from millions of patients that can
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help predict potential outcomes almost
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like specialized calculators for health
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Sounds a bit like science fiction right
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but is very real and is playing an
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increasingly important role in the
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healthcare today We're talking about
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clinical prediction calculators or risk
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stores So what are these things imagine
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researchers studying thousands even
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millions of patient cases over many
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years They look for patterns Does age
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affect recovery from this surgery how
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much does high blood pressure increase
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the risk of that complication does this
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set of lab results usually lead to a
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longer hospital stay they take all of
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these complex patterns and boil them
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down into a mathematical models
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Essentially these calculators the doctor
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can input specific information about an
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individual patient things like age
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existing health conditions lab results
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the type of procedures planned and the
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calculator uses that data to estimate
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the probability or the risk of certain
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things happening Now a huge disclaimer
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These calculators are not fortune
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tellers They provide probabilities based
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on large group of people not certainties
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for one individual Think about it like a
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weather forecast A 70% chance of rain
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means rain is likely but it doesn't
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guarantee you'll get wets These are
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tools to aid doctors and patients in
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understanding risk and making informed
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decisions together They are part of a
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much bigger picture that includes
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doctor's experience your specific
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situation test results and importantly
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your personal values and preferences So
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next time when you're discussing a
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health decision with your doctor don't
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be surprised if they mention a risk
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score or use one of these calculators
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It's a sign that they are using powerful
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data-driven tools to help personalize
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your care Pretty fascinating how data is
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shaping medicine right it's not about
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replacing the human touch but enhancing
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it with information What do you think
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about these prediction tools have you
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ever encountered one let me introduce
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some of these tools to you We first will
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start with some basic tools These are
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carnovski performance scale bartal index
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for activities of daily living and
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charlson comorbidity index Then we will
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discuss pum which is physiologic and
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operative severity score for the study
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of mortality and morbidity Let's start
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with carnowski performance scale
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Karnovski performance scale is a simple
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way for doctors and nurses to describe
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how well a person with an illness can do
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everyday activities It uses score from 0
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to 100 A higher score like 90 or 100
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means the person is doing pretty well
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and can take care of themselves and even
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work Lower scores mean the person needs
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more help with daily tasks Think of it
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as a snapshot of how the illness is
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affecting someone's life like whether
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they can go to work cook meals or even
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just get out of bed Doctors use a scale
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to understand how someone is doing plan
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their treatment and see if things are
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getting better or worse over time It's a
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straightforward way to communicate about
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a person's overall well-being and
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ability to function Excellent Let's move
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on to Bartell's index for activism of
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daily living For this we're going to use
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a website called mdcalc.com So
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mdc.com and in the search box you'll
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just type vortell and then it shows up
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And as you see it lists variety of
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activities that we do on a daily basis
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such as feeding bathing grooming
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dressing bowel and bladder control
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toilet use transfers from bed to the
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chair and back mobility on level
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surfaces stairs and then for each one
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you can select different options So
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let's say as one person for feeding that
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person needs some help that person is
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unable to do the baiting grooming no
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issue Let's say dressing needs some help
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Bowel control maybe some occasional
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accident Bladder control also some
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occasional accident Toilet use needs
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some help Transfers from bed to the
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chair and back and either select
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independent or you can select needs
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minor help with verbal or physical help
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or needs major help one or two people
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doing it physically but the person is
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able to sit by himself or herself or is
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unable to do any of that So let's say
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this person needs some major help And
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then the next question would be on
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mobility on level surfaces Here you can
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be independent You can use some aids
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like cane or walker but you should be
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able to walk more than 50 yards The next
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option is that you need help from one
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person either or physical but you're
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able to walk more than 50 yards The
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third option is that you're wheelchair
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independent including corners but you're
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able to do that for more than 50 yards
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And then the last option is either
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you're immobile let's say bedridden or
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you're able to walk less than 50 yards
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So for this person let's say the patient
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is able to walk with the help of one
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person And then the last one is stairs
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So you can be independent on going up
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and down the stairs or you may need some
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help either verbal physical or carrying
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aid like a chairlift or you're unable to
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do that So let's say you need some help
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with that too So now you see that the
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total score is 50 points and this person
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is partially dependent Then you can
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click on the next steps It tells you
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that lower scores indicate increasing
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disability and greater need for skilled
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care The total score and categorization
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may be used to help guide the extent of
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the interventions necessary in the
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management However scores within each
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variables are also important in guiding
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the focus of the treatment such as if
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you have problem with just transfers or
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baiting or grooming And then it provides
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some basic and general suggestions and
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recommendations So the followings are
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the basic measures that may be
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beneficial for patients but should be
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considered within the context of each
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patient So develop a comprehensive care
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plan involving a multi-disiplinary team
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Educate and train the family members and
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caregivers in providing assistance
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Ensure the patient has access to
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necessary resources for activities of
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daily living Educate the patient on
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energy conservation techniques and safe
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ways to perform activities of daily
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living Refer for occupational physical
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therapy structure to their needs to
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improve and maintain function Introduce
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adaptive equipment to assist with daily
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activities such as a special utensils
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for eating Grab bars and transfer boards
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Evaluate and modify the home environment
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to optimize safety such as wheelchair
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accessibility hospital bed and bedroom
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and bathroom aids arrange for community
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support services such as home meal
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delivery and home health aids and
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conduct regular assessments to monitor
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progress and adjust care plans
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accordingly So for patients with minimal
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to no needs schedule periodic checkups
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to ensure continued independence and
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continue to focus on health maintenance
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and preventive care and encourage
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participation in physical and social
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activity Excellent Let's move on to
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Charleston coorbidity index Again we go
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to the medal.com and in the search box
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type Charleston and then it brings it up
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So here you see that this assessment has
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a bunch of questions One of them is
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about age and the rest of it is about
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the medical conditions that you may have
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So let's start with the case Let's say
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you are 75 years old So you select 70 to
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79 years category And as you select the
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age it gives you the estimated 10ear
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survival So even if you have none of the
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illnesses that we're going to talk about
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the likelihood of you surviving 10 years
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is 77% because you are in this age
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category Now for the sake of argument
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let's say you're 82 As you see that 77%
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likelihood of you surviving 10 years is
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going to drop to 53% So that's how these
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sort of numbers do change as you enter
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different answers So now let's go back
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to the 75 year old So you start with 77%
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likelihood of living within the next 10
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years The first illness is mioardial
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inffection So if you have had heart
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attack so if you select yes for that
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just because of that it drops from 77%
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to 53% The next question is on heart
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failure shortness of breath leg swelling
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etc Let's say you did not have that
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peripheral vascular disease which is
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defined by intermittent claudication or
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past bypass for chronic arterial
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insufficiency history of gang green or
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acute arterial insufficiency or
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untreated thoracic or abdominal aneurysm
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which is more than 6 cm Let's say you
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did not have that The next illness is on
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cerebrovascular accident or transending
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schemic attack Let's say you had that
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And as you see with that yes you're now
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at 21% likelihood of living within the
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next 10 years You do not have dementia
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You were a former smoker and as a result
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of that you have some chronic pulmonary
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disease So you select yes And now we are
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at just 2% estimated 10ear survival So
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the rest which is the connective tissue
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disease peptic ulcer disease liver
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disease diabetes hemipalgia moderate or
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severe chronic kidney disease and
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whether you even have had solid tumors
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or not We are just focusing on that
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remaining 2% of estimated likelihood of
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living within that 10-year time frame So
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it's very important for you to take
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these numbers into account when you're
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deciding whether you should receive
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treatment or what sort of treatment for
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your cancer Let's say you're 75 years
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old but you have none of these illnesses
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that I just mentioned So let's select no
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for all of these So you see you are at
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77% likelihood of 10ear survival Now if
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you have a localized colon cancer that
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is going to drop to 21% So it's very
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important for you to think about these
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numbers when you decide whether you
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should have treatment for your localized
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or metastic cancer or not Obviously the
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more coorbidities the less likelihood
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that you're going to live within that 10
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years even without a diagnosis of cancer
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So that may be helpful in your decision
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making Excellent Let's move on to the
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next calculator So again we go to MD
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calculator and we are going to type pom
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p su m This is pom for operative
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morbidity and mortality risk So this
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risk calculator has two main scores One
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is the physiological score and the other
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one is operative severity score So let's
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first focus on physiological score The
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first point is your age Let's say you're
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82 Then it asks you about your cardiac
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condition So if you're not in heart
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failure you click on no failure If
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you're using some water pills or some
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other medications you select this one If
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you have had peripheral edema like leg
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swelling or if you're on blood tuners
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like warerin you select this and
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obviously this one is a lot more severe
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than the others Let's say you do not
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have any cardiac failure So you select
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no failure The next organ that it
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focuses on is respiratory So if you have
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no shortness of breath or dysna you
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select no dysna If you have a mild
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chronic obstructive pulmonary disease or
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you have some shortness of breath when
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walking you select this one If you have
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moderate chronic obstructive pulmonary
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disease or you have a shortness of
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breath that is limiting you more you
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select this third option And then
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obviously the fourth option is always a
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lot more severe So let's say you have
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some mild shortness of breath Then it
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ask you about your systolic blood
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pressure This is the high number on when
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you get your blood pressure So like
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usually 120 or 80 130 over 70 It's
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asking you about the higher number So
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let's say you usually run 140 And then
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it ask you about your heart rate So
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let's put it at 75 Glasco comma scale
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Again the higher number means that
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you're more alert and oriented You're
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conscious and so on This one I would
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suggest that you put 15 That's the type
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of patients that you're talking about
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Then it asks you about your hemoglobin
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or your red blood cells whether you're
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anemic or not So this is you can find it
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in your blood work result So let's say
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you're at 12.5 Then the next question is
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your white blood cell count Let's say
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you're 4.5 Then this is the bun or bun
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You can find that in the routine blood
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work that every patient has Let's put 25
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Then you have your sodium and potassium
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For sodium let's put 140 here for
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potassium that's before And then the
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next one it asks you about your EKG So
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if your EKG is normal you select this
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one If you're having a condition called
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atrial fibrillation or irregular heart
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rhythm you select this So to keep things
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simple let's select normal for your EKG
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So that is your physiological scores
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Then we move on to the operative
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severity score So operative severity for
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the sort of surgeries that we are
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talking about you are either undergoing
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major or major plus surgery Let's select
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major and then at times surgeons need to
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do more than one procedure at the same
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time So that's why this is a number of
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procedures one two or more than two
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Let's select one Estimated blood loss
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your surgeon has an idea about what
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would be the expectation for blood loss
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especially if you're undergoing
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laparoscopy surgery blood loss is going
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to be fairly minimal maybe 50 ml so
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let's say your surgeon is expecting that
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there might be just 50 cc's of blood
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loss the next question is on the peronal
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soiling again this is something that you
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need your surgeon's help but for the
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sake of argument let's select none and
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the next one is presence of malignancy
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diagnosed before or during surgery Let's
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say you're undergoing colon surgery So
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now you know that you have colon cancer
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So it's going to be either primary only
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whether there's lymph metastasis or this
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and metastases This metastases are
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obviously clear from the pre-operative
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imaging At times the lymph node status
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is unknown until the surgery is done But
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you can play with this So you can either
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select primary only first and then lymph
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node metastasis and see if the numbers
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change significantly and whether you
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need to take that into consideration
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Let's say you only have primary tumor
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and then the mode of surgery elective
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emergency within 24 hours or emergency
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within 2 hours If you're presenting to
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the emergency room with severe abdominal
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pain and the surgeon needs to operate on
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you right away that risk and stress of
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that surgery on your body just increases
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significantly So the expectation that
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you presented to the emergency room and
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you underwent surgery and as a result
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it's going to be a safe surgery I think
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at times is unrealistic expectation
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Let's say this is an elective surgery
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You've been diagnosed with cancer and
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the surgeon has scheduled you to undergo
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surgery in a matter of few weeks or so
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that is elective surgery So then it
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gives you these numbers that are very
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important for you to take into
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consideration So the likelihood of you
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dying during and little bit after the
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surgery usually within 30 days is 4.9%
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And then the predicted morbidity if you
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have complications or functional decline
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or additional assistant with your daily
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activities it is around 27 28% As you
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see the risk for both mortality and
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morbidity for this patient that we
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talked about is not 0% but it's also not
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50% The most important question for you
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is whether you think 5% risk of dying
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during and within 30 days after surgery
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is worth going over is worth going
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through that surgery or not and how much
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this 27 28% likelihood of functional
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decline needing some assistance maybe
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going to the rehab and so on would
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impact your decision making Again you
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can see how do these things change So we
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talked about the mode of surgery So this
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was for elective But now let's say you
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have had colon cancer but for variety of
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reason you needed to be rushed to the
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emergency room because of severe
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abdominal pain and they found that you
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have a bowel obstruction and now they
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need to do surgery maybe within 24 hours
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Right so now instead of doing the
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surgery on elective manner let's do it
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in emergency within 24 hours and see how
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these numbers change So as you see now
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the likelihood of you dying during and
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within that 30 day of surgery has
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increased to 7.7% And you're more than
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40% likely to have some morbidity and
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complications from that surgery Let's
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say this is now has become a very e
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surgery The surgery within 2 hours and
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that the numbers just jump significantly
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So that is why this calculator in my
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opinion is important It's a little bit
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complicated You may need some help from
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your doctors surgeons and primary care
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providers find the right answers for
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these questions But overall I think this
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will give you some idea about how things
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are
#Aging & Geriatrics
#Cancer
#Health Conditions