Clinical significance of palliative care assessment in patients referred for urgent intensive care unit admission: A cohort study.
To evaluate clinical characteristics of patients with palliative care (PC) and urgent intensive care unit (ICU) referrals in the same hospital admission.



All urgent ICU referrals at an academic, tertiary hospital, and the co-occurrence and timing of PC assessment were retrieved from a prospectively collected database.



From May 2014 to May 2015, 2476 patients were analyzed and 179 (7%) had co-occurrence of PC assessment and urgent ICU referral in the same hospital admission. Hospital mortality was higher (odds ratio, 8.3; 95% confidence interval, 5.4-12.7) and ICU admission was lower (odds ratio, 0.54; 95% confidence interval, 0.40-0.74) in patients with PC assessment, compared with patients without concurrent PC and ICU referrals. Variables associated with PC assessment were older age, diagnosis of cancer, depressed level of consciousness, nonsurgical admission, lower performance status, physician's subjective prognosis of poor outcome, and length of hospitalization before ICU referral.



In this cohort of patients with urgent ICU referral, clinical characteristics at the moment of ICU referral were associated with co-occurrence of PC assessment in the same hospital admission. These characteristics might guide the development of instruments to enhance early referral of high-risk patients to PC services.
Medical Sciences PhD Program, University of Sao Paulo Medical School, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil; UNIME Medical School, Lauro de Freitas, Brazil. Electronic address: jgrr25@gmail.com.
Joao Gabriel Rosa
JGR
Ramos
Medical Sciences PhD Program, University of Sao Paulo Medical School, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Camilo, iMED group, Sao Paulo, Brazil. Electronic address: mariodiegotc@yahoo.com.br.
Mario Diego
MD
Teles Correa
Palliative Care Team, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil. Electronic address: ricardotavaresfw@uol.com.br.
Ricardo Tavares
RT
de Carvalho
Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Austin Health, Melbourne, Australia. Electronic address: daryl.jones@austin.org.au.
Daryl
D
Jones
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Palliative Care Team, Hospital Sirio-Libanes, Sao Paulo, Brazil. Electronic address: dnforte@yahoo.com.br.
Daniel Neves
DN
Forte
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003244:Consciousness Disorders / Q000453:epidemiology*; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D010166:Palliative Care; D065126:Palliative Medicine; D011379:Prognosis; D012017:Referral and Consultation
Critically ill; End-of-life; Intensive care unit; Palliative care; Prognosis