Surprise Question and Performance Status Indicate Urgency of Palliative Care Needs in Patients with Advanced Cancer at the Emergency Department: An Observational Cohort Study

AbstractObjectivesWe aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection.MethodsWe undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set.ResultsWe analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, consciousness, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79-0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97-0.98) and specificity 0.34 (0.34-0.35) for scores above four points.ConclusionA clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care.RegistrationISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533

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Palliative Care and Rapid Emergency Screening Tool and the Palliative Performance Scale to Predict Survival of Older Adults Admitted to the Hospital From the Emergency Department

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120960713 ◽

2020 ◽

pp. 104990912096071

Author(s):

Jonas R. Te Paske ◽

Sarah DeWitt ◽

Robin Hicks ◽

Shana Semmens ◽

Leigh Vaughan

Keyword(s):

Older Adults ◽

Emergency Department ◽

Palliative Care ◽

South Carolina ◽

Performance Status ◽

Care Needs ◽

Vital Status ◽

Prognostic Utility ◽

Palliative Care Needs ◽

Performance Scale

Background: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool has been validated to identify patients in the emergency department (ED) with unmet palliative care needs, but no prognostic data have been published. The Palliative Performance Scale (PPS) has been validated to predict survival based on performance status and separately has been shown to predict survival among adults admitted to the hospital from the ED. Objective: To concurrently validate the 6-month prognostic utility of P-CaRES with a replication of prior studies that demonstrated the prognostic utility of the PPS among adults admitted to the hospital from the ED. Design: Prospective cohort study. Setting/Subjects: Adults >55 years admitted to the hospital from the ED at an urban academic hospital in South Carolina. Measurement: Baseline PPS score and P-CaRES status were evaluated within 51 hours of admission. Vital status at 6 months was evaluated by phone or chart review. Results: 131 of 145 participants completed the study. Six-month survival was 79.2% of those with a PPS of 60-100 (22/106 died) and 48% of those with a PPS of 10-50 (13/25 died) (p = 0.0004). Six-month survival was 85.2% for P-CaRES negative (13/88 died) and 48.8% for P-CaRES positive (22/43 died) (p < 0.0001). The inferred hazard ratio (HR) for PPS 10-50, as compared to PPS 60-100 was 3.003 (95%CI (1.475, 6.112) p = 0.0024) and the HR for P-CaRES positive, as compared to P-CaRES negative was 4.186 (95%CI (2.052, 8.536) p < 0.0001). Conclusion: The P-CaRES tool and PPS can predict 6-month survival of older adults admitted from the ED.

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Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study

PLoS ONE ◽

10.1371/journal.pone.0245840 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245840 ◽

Cited By ~ 1

Author(s):

Steve Goodacre ◽

Ben Thomas ◽

Laura Sutton ◽

Matthew Burnsall ◽

Ellen Lee ◽

...

Keyword(s):

Cohort Study ◽

Adverse Outcome ◽

Performance Status ◽

Multivariable Analysis ◽

Clinical Score ◽

Observational Cohort Study ◽

Clinical Severity ◽

Observational Cohort ◽

And Performance ◽

Ill Adults

Objectives We aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection. Methods We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set. Results We analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, consciousness, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79–0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97–0.98) and specificity 0.34 (0.34–0.35) for scores above four points. Conclusion A clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care. Registration ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533

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The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.15489 ◽

2021 ◽

Author(s):

Anthony Maraveyas ◽

Noémie Kraaijpoel ◽

George Bozas ◽

Chao Huang ◽

Isabelle Mahé ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Cancer Patients ◽

Prognostic Value ◽

Respiratory Symptoms ◽

Performance Status ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Observational Cohort ◽

And Performance

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Predictive variables of an emergency department quality and performance indicator: a 1-year prospective, observational, cohort study evaluating hospital and emergency census variables and emergency department time interval measurements

Emergency Medicine Journal ◽

10.1136/emermed-2012-201404 ◽

2012 ◽

Vol 30 (8) ◽

pp. 638-645 ◽

Cited By ~ 26

Author(s):

Enrique Casalino ◽

Christophe Choquet ◽

Julien Bernard ◽

Abigael Debit ◽

Benoit Doumenc ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Performance Indicator ◽

Observational Cohort Study ◽

Time Interval ◽

Prospective Observational Cohort Study ◽

Predictive Variables ◽

Observational Cohort ◽

And Performance

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A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063171 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3171

Author(s):

Ana A. Esteban-Burgos ◽

María José Lozano-Terrón ◽

Daniel Puente-Fernandez ◽

César Hueso-Montoro ◽

Rafael Montoya-Juárez ◽

...

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Statistical Significance ◽

Nursing Home Residents ◽

Cross Sectional Study ◽

Care Needs ◽

Chronic Patients ◽

Cross Sectional ◽

Surprise Question ◽

Palliative Care Needs

Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.

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