Criterion validity and inter-rater reliability of a palliative care screening tool for patients admitted to an emergency department intensive care unit.
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.ResultA 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 resultsThis 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.
['Corrêa da Costa Ribeiro|Sabrina|S|', 'Tavares de Carvalho|Ricardo|R|', 'Aparecida Rocha|Juraci|J|', 'Daglius Dias|Roger|R|0000-0003-4959-5052']
D000368:Aged D004636:Emergency Service, Hospital D005260:Female D006801:Humans D008297:Male D008403:Mass Screening D008875:Middle Aged D015588:Observer Variation D010166:Palliative Care D015203:Reproducibility of Results D012189:Retrospective Studies D012720:Severity of Illness Index D000072878:Simplified Acute Physiology Score
Palliative care emergency department critical care prognostication