A-qCPR risk score screening model for predicting 1-year mortality associated with hospice and palliative care in the emergency department. (February 2021)

• Record Type: Journal Article
• Authors: Wang, Ruei-Fang; Lai, Chao-Chih; Fu, Ping-Yeh; Huang, Yung-Chung; Huang, Sheng-Jean; Chu, Dachen; Lin, Shih-Pin; Chaou, Chung-Hsien; Hsu, Chen-Yang; Chen, Hsiu-Hsi
• Is Part Of: Palliative medicine. Volume 35:Number 2(2021)
• Page Start: 408
• Page End: 416
• Publication Date: 2021-02
• Subjects: Emergency department -- palliative -- hospice -- performance status score -- qSOFA -- DNR; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/0269216320972041
• Languages: English
• ISSNs: 0269-2163

Abstract

Background: Evaluating the need for palliative care and predicting its mortality play important roles in the emergency department. Aim: We developed a screening model for predicting 1-year mortality. Design: A retrospective cohort study was conducted to identify risk factors associated with 1-year mortality. Our risk scores based on these significant risk factors were then developed. Its predictive validity performance was evaluated using area under receiving operating characteristic analysis and leave-one-out cross-validation. Setting and participants: Patients aged 15 years or older were enrolled from June 2015 to May 2016 in the emergency department. Results: We identified five independent risk factors, each of which was assigned a number of points proportional to its estimated regression coefficient: age (0.05 points per year), qSOFA ⩾ 2 (1), Cancer (4), Eastern Cooperative Oncology Group Performance Status score ⩾ 2 (2), and Do-Not-R esuscitate status (3). The sensitivity, specificity, positive predictive value, and negative predictive value of our screening tool given the cutoff larger than 3 points were 0.99 (0.98–0.99), 0.31 (0.29–0.32), 0.26 (0.24–0.27), and 0.99 (0.98–1.00), respectively. Those with screening scores larger than 9 points corresponding to 64.0% (60.0–67.9%) of 1-year mortality were prioritized for consultation and communication. The area under the receiving operating characteristic curves for the point system was 0.84 (0.83–0.85) for the cross-validation model. Conclusions: A-qCPR risk scores provide a good screening tool for assessing patient prognosis. Routine screening for end-of-life using this tool plays an important role in early and efficient physician-patient communications regarding hospice and palliative needs in the emergency department.