A Study to Identify Predictors of Death within 72 Hours after Presentation to an Acute Hospital in Singapore

Early involvement of palliative care in emergency departments can optimize symptom control and enhance psychosocial support to improve satisfaction with care. We aim to identify predictive factors of death by analyzing case records of patients who died within 72 hours of presentation to the emergency department of an acute hospital from 1st September to 31st October 2014. Forty-six cases, 26 (56%) males and 20 (44%) females, age ranging from 35 to 90 years were identified of which 35 (76%) were above 60 years old. Ten cases came from nursing homes and 30 (65%) needed partial or complete assistance in basic activities of daily living. Nine (20%) had advanced malignancy and 9 (20%) suffered from end stage renal, cardiac or lung disease. Infection (27, 59%) was most common reason for presentation followed by complications of advanced malignancy, stroke or heart failure. Hypotension (31, 61%), unstable heart rate (27, 58%), acidosis (26, 57%) and low oxygen saturation (23, 50%) were present at triage. This study identified age, dependency, advanced malignancy or end organ diseases presenting with unstable parameters or acidosis as potential predictors of death and can guide emergency departments in integration of palliative care while treating potentially reversible infections. More studies are required to assess the robustness of the predictive factors.