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Criterion validity and inter-rater reliability of a palliative care screening tool for patients admitted to an emergency department intensive care unit

Published online by Cambridge University Press:  26 December 2017

Sabrina Corrêa da Costa Ribeiro ,
Ricardo Tavares de Carvalho ,
Juraci Aparecida Rocha  and
Roger Daglius Dias Open the ORCID record for Roger Daglius Dias [Opens in a new window]
Sabrina Corrêa da Costa Ribeiro
Affiliation:
Emergency Department of Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
Ricardo Tavares de Carvalho
Affiliation:
Palliative Care Service of Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
Juraci Aparecida Rocha
Affiliation:
Palliative Care Service of Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
Roger Daglius Dias*
Affiliation:
Emergency Department of Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (current affiliation)
*
Author for correspondence: Roger Daglius Dias, STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, 10 Vining Street, 02215, Boston, MA 02115. E-mail: rdias@bwh.harvard.edu
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Abstract

Objective

The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU).

Method

Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two “surprise questions” (traditional and modified). Patients were classified at ED-ICU admission in four categories according to the proposed algorithm.

Result

A total of 510 patients were included in the analysis. From these, 337 (66.1%) were category 1, 0 (0.0%) category 2, 63 (12.4%) category 3, and 110 (21.6%) category 4. Severity of illness (Simplified Acute Physiology Score III score and mechanical ventilation), mortality (ED-ICU and intrahospital), and PC-related measures (order for a PC consultation, time between admission and PC consultation, and transfer to a PC bed) were significantly different across groups, more evidently between categories 4 and 1. Category 3 patients presented similar outcomes to patients in category 1 for severity of illness and mortality. However, category 3 patients had a PC consultation ordered more frequently than did category 1 patients. The screening criteria were assessed by two independent raters (n = 100), and a substantial interrater reliability was found, with 80% of agreement and a kappa coefficient of 0.75 (95% confidence interval = 0.62, 0.88).

Significance of results

This study is the first step toward the implementation of a PC screening tool in the ED-ICU. The tool was able to discriminate three groups of patients within a spectrum of increasing severity of illness, risk of death, and PC needs, presenting substantial inter-rater reliability. Future research should investigate the implementation of these screening criteria into routine practice of an ED-ICU.

Keywords

Palliative careemergency departmentcritical careprognostication
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 685 - 691
Copyright
Copyright © Cambridge University Press 2017 

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