Why did you develop the GO-FAR Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
As clinicians, we're not very good about routinely addressing DNR status with our hospitalized patients. As a result, many patients with a poor prognosis experience CPR and only rarely benefit. My goal was to be able to use information available on admission to identify patients at high risk for a poor outcome.
What pearls, pitfalls and/or tips do you have for users of the GO-FAR Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?
The clinical decision rule is intended for use in inpatients, and should serve as a backup to clinical judgment and a value-based discussion with the patient about their goals for treatment. It is not a substitute for judgment, and has not been validated in outpatients or in the out of hospital setting.
What recommendations do you have for doctors once they have applied the GO-FAR Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?
Increasing rates of survival to discharge with a good neurologic outcome may necessitate recalibration of the score. In a prospective validation study (currently in review), we found that increasing the cutoff for very low likelihood of a good outcome to 26+ points from 24+ points would classify 3,380 patients in this group, of whom 52 survive (1.5%); increasing it to 28+ points would classify 2,394 patients in this group, of whom 29 survive (1.2%).
Any other research in the pipeline that you’re particularly excited about?
We are working on a series of studies to attempt to validate decision support tools to help primary care physicians determine which patients with a respiratory infection need an antibiotic, and the much larger group that do not.