Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Orthopaedic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Acad Emerg Med. 2022 Oct;29(10):1229-1246. doi: 10.1111/acem.14492. Epub 2022 Jun 14.
This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED).
A comprehensive search of electronic databases and the gray literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction, and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQRs).
A total of 35 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n = 12 studies), followed by the Palliative Care and Rapid Emergency Screening (P-CaRES) tool (n = 8), and the screening for palliative and end-of-life care needs in the emergency department (SPEED) instrument (n = 4). Twelve of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (63%, IQR 38%-78%) and specificity (75%, IQR 57%-84%) of the SQ to predict mortality at 1 or 12 months was moderate. While the median positive predictive value of the SQ was low (32%, IQR 16%-40%), the median negative predictive value was high (91%, IQR 88%-95%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%.
This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.
本系统评价确定并评估了现有的筛查工具的心理测量特性，以识别急诊科（ED）中未满足的姑息治疗（PC）需求的患者。
对电子数据库和灰色文献进行了全面检索。两名独立的审查员完成了研究筛选和纳入、数据提取和质量评估。使用中位数和四分位距（IQR）报告结果的描述性总结。
共纳入 35 项研究，涉及 14 种独特的筛查工具的评估。使用最广泛的筛查工具是意外问题（SQ；n=12 项研究），其次是姑息治疗和快速急诊筛查（P-CaRES）工具（n=8 项研究）和急诊姑息和临终关怀需求筛查（SPEED）工具（n=4 项研究）。纳入的 12 项研究报告了筛查工具的心理测量特性，其中 8 项研究评估了 SQ 预测患者死亡率的性能。总体而言，SQ 预测 1 个月或 12 个月死亡率的敏感度（63%，IQR 38%-78%）和特异性（75%，IQR 57%-84%）为中等。虽然 SQ 的阳性预测值中位数较低（32%，IQR 16%-40%），但阴性预测值中位数较高（91%，IQR 88%-95%）。在这些研究中，根据筛查工具的标准，被确定为有未满足的 PC 需求的患者比例从 5%到 83%不等。
本综述确定了 14 种用于识别急诊科有未满足的 PC 需求的成年患者的独特筛查工具。发现一种筛查工具，即 SQ，具有中等的敏感度和特异性，可准确预测未来患者的死亡率。在广泛实施之前，需要进一步研究以更好地了解该工具和其他现有工具的临床价值。
