• Ruei-Fang Wang, Chao-Chih Lai, Ping-Yeh Fu, Yung-Chung Huang, Sheng-Jean Huang, Dachen Chu, Shih-Pin Lin, Chung-Hsien Chaou, Chen-Yang Hsu, and Hsiu-Hsi Chen.
• Department of Emergency Medicine, Taipei City Hospital, Taipei.
• Palliat Med. 2021 Feb 1; 35 (2): 408-416.

BackgroundEvaluating the need for palliative care and predicting its mortality play important roles in the emergency department.AimWe developed a screening model for predicting 1-year mortality.DesignA 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 ParticipantsPatients aged 15 years or older were enrolled from June 2015 to May 2016 in the emergency department.ResultsWe 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-Resuscitate 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.ConclusionsA-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.

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