Validation of the Patient-Reported Outcome Mortality Prediction Tool (PROMPT)

Abstract Context The Patient-Reported Outcome Mortality Prediction Tool (PROMPT) estimates six-month mortality risk in elderly patients with declining health, but its external validity has not been established. Objectives To prospectively validate the PROMPT in an independent patient cohort and explore its clinical utility. Methods The study cohort comprised a diverse sample of 467 patients aged 65 years and older. Model calibration and discrimination were assessed on the original PROMPT and in two updated models. Clinical utility of the final updated PROMPT was examined using decision curve analysis. Results The validation cohort had a lower six-month mortality rate than the derivation cohort (6.9% vs. 15.0%). Discrimination was virtually unchanged (area under the curve 0.73 compared with 0.75), but calibration was suboptimal ( P Conclusion The PROMPT demonstrated good discrimination but poor calibration in an independent heterogeneous clinical population. Model updating improved calibration and diagnostic performance and decision curve analysis demonstrated potential clinical utility of the PROMPT for initiating advance care planning rather than hospice referrals.