SPICT as a predictive tool for risk of 1-year health degradation and death in older patients admitted to the emergency department: a bicentric cohort study in Belgium

• Published in: BMC palliative care 2023-06, Vol.22 (1), p.79-79, Article 79
• Main Authors: Bourmorck, Delphine, de Saint-Hubert, Marie, Desmedt, Marianne, Piers, Ruth, Flament, Julien, De Brauwer, Isabelle
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Aged patients; Aged, 80 and over; Belgium; Care and treatment; Casualties; Chronic diseases; Cohort analysis; Cohort Studies; Comorbidity; Complications and side effects; COVID-19; Data collection; Diagnosis; Disease; Emergency Department; Emergency medical care; Emergency service; Emergency Service, Hospital; Female; Hospitals; Humans; Institutionalization; Male; Medical prognosis; Medical research; Mortality; Older patients; Older people; Palliative Care; Palliative treatment; Pandemics; Patients; Prognosis; Prospective Studies; Services; SPICT; Variables
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-023-01201-9

Older patients are increasingly showing multi-comorbidities, including advanced chronic diseases. When admitted to the emergency department (ED), the decision to pursue life-prolonging treatments or to initiate a palliative care approach is a challenge for clinicians. We test for the first time the diagnostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT) in the ED to identify older patients at risk of deteriorating and dying, and timely address palliative care needs. We conducted a prospective bicentric cohort study on 352 older patients (≥ 75 years) admitted to two EDs in Belgium between December 2019 and March 2020 and between August and November 2020. SPICT (French version, 2019) variables were collected during the patients' admission to the ED, along with socio-demographic, medical and functional data. The palliative profile was defined as a positive SPICT assessment. Survival, symptoms and health degradation (≥ 1 point in ADL Katz score or institutionalisation and death) were followed at 12 months by phone. Main accuracy measures were sensitivity, specificity and likelihood ratios (LR) as well as cox regression, survival analysis using the Kaplan Meier method, and ordinal regression. Out of 352 patients included in the study (mean age 83 ± 5.5 years, 43% male), 167 patients (47%) had a positive SPICT profile. At one year follow up, SPICT positive patients presented significantly more health degradation (72%) compared with SPICT negative patients (35%, p