Korean J Hosp Palliat Care.  2011 Mar;14(1):28-33.

Predictability of Impending Events for Death within 48 Hours in Terminal Cancer Patients

Affiliations
  • 1Department of Family Medicine, Gachon University of Medicine and Science, Incheon, Korea.
  • 2Clinical Trial Center, Yonsei University Health System, Seoul, Korea.
  • 3Department Family Medicine, Yonsei University College of Medicine, Seoul, Korea. hope@yuhs.ac

Abstract

PURPOSE
Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death.
METHODS
Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death.
RESULTS
The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant.
CONCLUSION
The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.

Keyword

Death; Prognosis; Terminally ill; Neoplasms

MeSH Terms

Blood Pressure
Caregivers
Dyspnea
Humans
Medical Records
Oxygen
Palliative Care
Prognosis
Terminally Ill
Oxygen
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