Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019

Abstract

The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in the ED. A retrospective observational study was conducted using the National Emergency Department Information System (NEDIS) database. Patients who died during ED care between 2016 and 2019 were included. Palliative care-eligible disease was defined as cancer (C00–C99 of ICD-10), chronic respiratory disease (CRD, J44–J46), chronic liver disease (CLD, K70–K77), and heart failure (HF, I50). Among the 36,538,486 ED visits during 4 years, 34,086 ED deaths were included. The crude incidence rate of ED deaths per 100,000 person-year was steady between 16.6 in 2016 and 16.3 in 2019 (p-for-trend = 0.067). Only 3370 (9.9%) ED deaths were injury, while 30,716 (90.1%) deaths were related to diseases. The most common ED diagnosis was cardiac arrest (22.1%), followed by pneumonia (8.6%) and myocardial infarction (4.7%). In cases of disease-related ED deaths, about 34.0% stayed longer than 8 h in the ED (median (interquartile range): 4.5 (1.9–11.7) h) and 44.2% received cardiopulmonary resuscitation (CPR) at end-of-life time. A quarter of the disease-related ED deaths were diagnosed with palliative care eligible disease: cancer (16.9%), CLD (3.8%), HF (3.5%), and CRD (1.4%). Cancer patients received less CPR (23.4%) and stayed longer in the ED (median (interquartile range): 7.3 (3.2–15.9) h). Over the past 4 years, more than 30,000 patients, including 5200 cancer patients, died during care in the ED. A quarter of disease-related ED death were patients with palliative care-eligible condition and more than 30% of them stayed longer than 8 h in the ED before death. It is time to discuss about need of palliative care in the ED.

The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand

“…In our study, based on the palliative care encounter indicator, nearly half of older patients appeared to present with an understanding that they might be at their end of life. Based on other studies, a palliative approach would be appropriate for about one-quarter to one-half of older patients [ 15–17 ]. Despite guidelines and recommended geriatric ED model designs [ 30–32 ], few EDs are set up to manage the special needs of the older person [ 33 , 34 ], regardless of whether they present at end of life.…”

“…Few other estimates of the incidence of death in ED or shortly thereafter exist. One population-based Korean study reports an ED death rate of 0.3% (all ages), and that approximately one-quarter of patients who died in ED would have been considered appropriate for palliative care based on pre-existing health conditions [ 15 ]. A second single-site study from Singapore found that more than half of older persons who died in ED were chronically unwell and more likely to benefit from palliative care [ 16 ].…”

Home extubation in a terminally ill older patient visiting emergency department

“…Another study reported that 40.7% of PC patients coming to ED died in a hospital [9]. The prevalence of ED visits among PC patients has been reported to range from 13.2% to 25% [10,11]. However, it is important to note that the availability of data relating to this subject is currently limited [12].…”

Haemoglobin and C-reactive protein levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in emergency department patients

“…As the frequency of advanced diseases becomes more common, there is a corresponding rise in ED visits for individuals with chronic illnesses. For example, in the period 2016–2019 in Korea, only 10% of deaths that occurred in the ED were attributed to injuries, while a staggering 90% of the deaths were linked to various diseases, and more than half of elderly patients who passed away in the ED had significant chronic illnesses [ 1 ]. Drawing from yet another extensive cohort of over a hundred million ED patients, the study’s authors reached the conclusion that there is a need to identify patients for whom end-of-life care is either necessary or preferred, and to ensure they are equipped to receive this care at an excellent standard (highlighting older patients who are more likely to be White, male, not Hispanic, and possess a higher Charlson Comorbidity Index) [ 2 ].…”