Development and Validation of a Clinician-Administered Questionnaire for Evaluating Arista Lakshana (Fatal Signs) in Critically Ill Patients Validation of the Arista Lakshana Questionnaire

Abstract

Ancient Ayurvedic scriptures describe Arista Lakshana (fatal signs) as indicators of poor prognosis and impending death, but their relevance in modern clinical practice remains uncertain. Previous studies relied on unstructured bedside observations and retrospective chart reviews without using a validated assessment framework. This study aimed to design, develop, and evaluate a clinician-administered questionnaire for assessing Varna (color) and Sparsha (touch) Arista Lakshana in critically ill patients. A prospective study was conducted in the Medical Intensive Care Unit (MICU) of a tertiary care hospital from May 2023 to May 2025. The questionnaire was developed through literature review and expert consultation, covering Varna categories, Sparsha parameters, and anatomical sites. Content validity was established by expert evaluation. Predictive validity was assessed using mortality at 7, 15, 28, 90, 180, and 365 days, while construct validity was evaluated through hypothesis testing based on expected dose-response gradients. Robustness and interpretability were examined using data completeness and risk stratification. High-intensity Varna abnormalities (blue, reddish) and Sparsha findings (tachypnoea, tachycardia) were associated with increased early and late mortality. Combined Varna–Sparsha abnormalities showed stronger prognostic value than isolated findings. The questionnaire demonstrated strong validity, feasibility, and clinical utility for mortality prediction in critically ill patients.