Identifying patients with unmet palliative care (PC) needs in the emergency department (ED) is crucial. This article examines the available screening tools designed for this purpose, focusing on their effectiveness and psychometric properties. This review is vital for healthcare professionals aiming to improve patient care in emergency settings.
This systematic review explored various databases and grey literature to find studies assessing screening tools for palliative care needs in the ED. Two independent reviewers rigorously screened studies, extracted data, and evaluated the quality of the included research. The findings are summarized using medians and interquartile ranges (IQRs) to provide a clear overview of the current landscape.
Our comprehensive search identified 35 relevant studies, evaluating 14 distinct screening tools. The most frequently studied tool was the surprise question (SQ), featured in 12 studies. The Palliative Care and Rapid Emergency Screening (P-CaRES) tool was assessed in 8 studies, and the screening for palliative and end-of-life care needs in the emergency department (SPEED) instrument was examined in 4. Among these studies, twelve reported on the psychometric properties of these screening tools, with eight specifically focusing on the SQ’s ability to predict patient mortality.
The surprise question demonstrated moderate accuracy in predicting mortality at both 1-month and 12-month intervals. The median sensitivity was 63% (IQR 38%-78%), indicating its ability to correctly identify 63% of patients who would experience mortality. The median specificity was 75% (IQR 57%-84%), showing that it correctly identified 75% of patients who would survive. However, the positive predictive value of the SQ was low at a median of 32% (IQR 16%-40%), suggesting it may have a higher rate of false positives. Conversely, the negative predictive value was high, with a median of 91% (IQR 88%-95%), indicating a strong ability to correctly identify patients not at risk of mortality. Across all studies, the proportion of patients identified as having unmet palliative care needs varied significantly, ranging from 5% to 83%, depending on the screening tool and criteria used.
This review highlights the existence of 14 different screening tools designed to identify adult patients with unmet palliative care needs within the emergency department. Among these, the surprise question stands out as having moderate sensitivity and specificity in predicting future patient mortality. However, to fully understand the clinical utility of the SQ and other available screening tools, further research is essential before widespread implementation in emergency departments can be recommended. More studies are needed to validate these tools and assess their impact on patient outcomes and palliative care delivery in the ED setting.
