title: Clinical changes in terminally ill cancer patients and death within 48 h: when should we refer patients to a separate room?
abstract: BACKGROUND
  There is scant research concerning the prediction of imminent death, and current studies simply list events "that have already occurred" around 48 h of the death. We sought to determine what events herald the onset of dying process using the length of time from "any change" to death.
  
  
  METHODS
  This is a prospective observational study with chart audit. Inclusion criteria were terminal cancer patients who passed away in a palliative care unit. The analysis was limited to 181 patients who had medical records for their final week. Commonly observed events in the terminally ill were determined and their significant changes were defined beforehand. We selected the statistically significant changes by multiple logistic regression analysis and evaluated their predictive values for "death within 48 h."
  
  
  RESULTS
  The median age was 67 years and there were 103 male patients. After adjusting for age, sex, primary cancer site, metastatic site, and cancer treatment, multiple logistic regression analyses for association between the events and "death within 48 h" revealed some significant changes: confused mental state, decreased blood pressure, increased pulse pressure, low oxygen saturation, death rattle, and decreased conscious level. The events that had higher predictability for death within 48 h were decreased blood pressure and low oxygen saturation, and the positive and negative predictive values of their combination were 95.0 and 81.4%, respectively.
  
  
  CONCLUSIONS
  The most reliable events to predict impending death were decreased blood pressure and low oxygen saturation.
authors.affiliation: Department of Family Medicine, Gachon University Gil Hospital, Incheon, South Korea. spfe0211@gmail.com
authors.forename: In Cheol
authors.initials: IC
authors.lastname: Hwang
authors.forename: Hong Yup
authors.initials: HY
authors.lastname: Ahn
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Park
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Shim
authors.forename: Kyoung Kon
authors.initials: KK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015331:Cohort Studies; D003643:Death; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D010100:Oxygen / Q000378:metabolism; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill / Q000706:statistics & numerical data*
chemical_list: D010100:Oxygen