Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department
Issued Date
2025-12-01
Resource Type
eISSN
20452322
Scopus ID
2-s2.0-85218695116
Journal Title
Scientific Reports
Volume
15
Issue
1
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SCOPUS
Bibliographic Citation
Scientific Reports Vol.15 No.1 (2025)
Suggested Citation
Charascharungkiat T., Tienpratarn W., Yuksen C., Bumrungsiri C., Pongsettakul N., Prachanukool T. Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department. Scientific Reports Vol.15 No.1 (2025). doi:10.1038/s41598-025-90593-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/105509
Title
Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department
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Abstract
Background End-of-life (EOL) care aims to facilitate good death and fulfill the patient’s final desires. Despite the known benefits of palliative consultations, emergency physicians encounter challenges in decision-making due to limited palliative resources. Previous studies primarily focus on non-emergency settings; thus, we aimed to develop a practical prediction score for 7-day mortality for palliative patients in the emergency department (ED). Methods This retrospective cohort study, conducted at a tertiary-level university hospital in Thailand between June 2022 and May 2023, evaluated adult palliative patients who declined life-sustaining treatments. Variables associated with 7-day mortality were analyzed using univariable and multivariable logistic regression. Results Of 499 ED visits, 152 patients (30.46%) died within seven days. Six predictors were identified: solid malignancy, respiratory with mandibular movement, systolic blood pressure < 100 mmHg, lymphopenia, thrombocytopenia, and a blood urea nitrogen to creatinine ratio > 20. These factors were used to develop the Ramathibodi End-of-life (RAMA-EOL) score, demonstrating an AuROC curve of 80.46% (95% CI: 76.15–84.77). Patients with a score ≥ 3 had a positive likelihood ratio of 2.92 (95% CI: 2.38–3.57) for 7-day mortality. Conclusion The RAMA-EOL score reliably predicts 7-day mortality in palliative ED patients, facilitating timely palliative care interventions for high-risk individuals.