For Stroke, 1 and 2 should be met. For COMA, 1 and 3 should be met.
1. Impairment of Functional Status (both a & b must be met)
a. Is Karnofsky Performance Status (KPS) < 40?
b. Is Palliative Performance Status (PPS) < 40?
2. Weight Loss (any one of the following must be met)
Documented inability to maintain hydration and caloric intake with any one of the following
a. Weight loss > 10% in the last 6 months or > 7.5% in the last 3 months?
b. Serum Albumin < 2.5 gm/dl?
c. Current Hx of pulmonary aspiration not responsive to speech language pathology intervention? (Sequential calorie counts documenting inadequate caloric/fluid intake)
d. Dysphagia severe enough to prevent patient from continuing fluids/foods necessary to sustain life and patient does not receive artificial nutrition and hydration?
B. COMA (any etiology)
3. Comatose Status (and three of the following must be met on day of coma)
a. Abnormal brain stem response?
b. Absence of verbal response?
c. Absence of withdrawal response to pain?
d. Serum creatinine > 1.5 mg/dl?