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<p><b>Background</b> End-of-life (EOL) care aims to facilitate good death and fulfill the patient’s final desires. Despite the known benefits of palliative consultations, emergency physicians encounter challenges in decision-making due to limited palliative resources. Previous studies primarily focus on non-emergency settings; thus, we aimed to develop a practical prediction score for 7-day mortality for palliative patients in the emergency department (ED). <b>Methods</b> This retrospective cohort study, conducted at a tertiary-level university hospital in Thailand between June 2022 and May 2023, evaluated adult palliative patients who declined life-sustaining treatments. Variables associated with 7-day mortality were analyzed using univariable and multivariable logistic regression. <b>Results</b> Of 499 ED visits, 152 patients (30.46%) died within seven days. Six predictors were identified: solid malignancy, respiratory with mandibular movement, systolic blood pressure &lt; 100 mmHg, lymphopenia, thrombocytopenia, and a blood urea nitrogen to creatinine ratio &gt; 20. These factors were used to develop the Ramathibodi End-of-life (RAMA-EOL) score, demonstrating an AuROC curve of 80.46% (95% CI: 76.15–84.77). Patients with a score ≥ 3 had a positive likelihood ratio of 2.92 (95% CI: 2.38–3.57) for 7-day mortality. <b>Conclusion</b> The RAMA-EOL score reliably predicts 7-day mortality in palliative ED patients, facilitating timely palliative care interventions for high-risk individuals. </p>

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Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月24日

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  • Torntarn Charascharungkiat,
  • Welawat Tienpratarn,
  • Chaiyaporn Yuksen,
  • Chalermpon Bumrungsiri,
  • Natthakorn Pongsettakul,
  • Thidathit Prachanukool

摘要

Background End-of-life (EOL) care aims to facilitate good death and fulfill the patient’s final desires. Despite the known benefits of palliative consultations, emergency physicians encounter challenges in decision-making due to limited palliative resources. Previous studies primarily focus on non-emergency settings; thus, we aimed to develop a practical prediction score for 7-day mortality for palliative patients in the emergency department (ED). Methods This retrospective cohort study, conducted at a tertiary-level university hospital in Thailand between June 2022 and May 2023, evaluated adult palliative patients who declined life-sustaining treatments. Variables associated with 7-day mortality were analyzed using univariable and multivariable logistic regression. Results Of 499 ED visits, 152 patients (30.46%) died within seven days. Six predictors were identified: solid malignancy, respiratory with mandibular movement, systolic blood pressure < 100 mmHg, lymphopenia, thrombocytopenia, and a blood urea nitrogen to creatinine ratio > 20. These factors were used to develop the Ramathibodi End-of-life (RAMA-EOL) score, demonstrating an AuROC curve of 80.46% (95% CI: 76.15–84.77). Patients with a score ≥ 3 had a positive likelihood ratio of 2.92 (95% CI: 2.38–3.57) for 7-day mortality. Conclusion The RAMA-EOL score reliably predicts 7-day mortality in palliative ED patients, facilitating timely palliative care interventions for high-risk individuals.