DNAR prognosis pathway

Pilot version created by Dr Sakthiswaran Rajasekar, UCSI Hospital, Port Dickson. Not yet validated with local data.

Input factors

Age

Age matters, but frailty and function are stronger signals.

ADL status

Clinical Frailty Scale

Frailty is one of the strongest pre-arrest predictors.

Comorbidity burden

Malignancy

Oxygen requirement

Organ involvement

Shock

Output

No meaningful survival likely

82 / 100 risk

High-risk DNAR profile

Severe frailty, dependency, shock, oxygen need, and organ involvement point toward a low chance of CPR leading to good recovery.

Meaningful survival8%

Mortality / poor outcome92%

Main driverFrailty

Interpretation: This is a pilot bedside aid for DNAR discussions at UCSI Hospital, Port Dickson. It is not a substitute for clinician judgment, patient wishes, or local policy, and it has not yet been validated with local data at UCSI Hospital or elsewhere.

Evidence used in the pathway

Finding	Published data	How it is used
Frailty and in-hospital CPR	In one older-adult cohort, CFS 1-3 mortality 54%, CFS 4 66%, CFS 5 78%, CFS 6 84%, CFS 7-9 84%.	Core frailty anchor for prognosis.
Frailty vs non-frailty	Survival to discharge 31.7% for CFS 1-5 vs 1.8% for CFS 6-9 in one study; other study found no frail patients survived to discharge.	Severe frailty pushes result toward no meaningful survival.
Age and frailty	Age correlated with frailty (Spearman 0.512 in one study).	Age is a modifier, not the main driver.
DNACPR decisions in ED	DNACPR patients were older, more comorbid, more frail, and had 1-year mortality 76.9% vs 12.9% without DNACPR in one cohort.	Supports a pre-arrest DNAR pathway.

Pilot tool created by Dr Sakthiswaran Rajasekar at UCSI Hospital, Port Dickson. Observational evidence only; this pathway is deliberately conservative and has not yet been validated with local data. Use with goals-of-care context.