KMID : 0856920110140010028
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Journal of Hospice and Palliative Care 2011 Volume.14 No. 1 p.28 ~ p.33
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Predictability of Impending Events for Death within 48 Hours in Terminal Cancer Patients
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Hwang In-Cheol
Choi Chung-Hyun Kim Kyoung-Kon Lee Kyoung-Shik Suh Heuy-Sun Shim Jae-Yong
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Abstract
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Purpose: Recognition of impending death is crucial not only for efficient communication with the caregiver of
the patient, but also determination of the time to refer to a separate room. Current studies simply list the events
¡®that have already occurred¡¯ around 48 hours before the death. This study is to analyze the predictability of each
event by comparing the time length from ¡®change¡¯ to death.
Methods: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of ¡®significant change¡¯ of each event before death.
Results: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant.
Conclusion: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
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KEYWORD
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Death, Prognosis, Terminally ill, Neoplasms
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