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Background <p>Integrating palliative care (PC) into emergency departments (EDs) is increasingly recognized as a strategy to support decision-making and avoid non-beneficial interventions near the end of life. However, evidence remains limited regarding its association with cardiopulmonary resuscitation (CPR) decisions in patients with poor prognosis.</p> Methods <p>We conducted a retrospective cohort study at a tertiary emergency hospital in Brazil, including adult inpatients who died between 2014 and 2024. The primary outcome was the occurrence of CPR during hospitalization. Patients were classified based on whether they received a PC consultation. Time to CPR was analyzed using Cox proportional hazards models adjusted for age, sex, comorbidities, and admission year. CPR attempts were identified using a validated natural language processing (NLP) approach applied to electronic health records (EHRs), with a Kappa agreement of 0.70 (95% CI: 0.61–0.79) compared to manual chart review.</p> Results <p>Among 6,211 patients, 1,757 (28.5%) received a PC consultation before death. PC consultation was independently associated with a lower likelihood of CPR, with an adjusted hazard ratio (HR) of 0.35 (95% CI: 0.32–0.39; p &lt; 0.001). In a sensitivity analysis limited to patients who died within 24 hours of admission, the association remained significant (HR: 0.26; 95% CI: 0.18–0.37; p &lt; 0.001).</p> Conclusions <p>In this cohort of hospitalized patients who died, palliative care consultation before any CPR attempt was associated with lower rates of CPR, possibly reflecting earlier or more thorough discussions of treatment preferences.</p>

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Association between palliative care in the emergency department and cardiopulmonary resuscitation decisions in patients with poor prognosis: a retrospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月9日

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  • Thiago Henrique dos Santos,
  • Rildo Pinto da Silva,
  • Mateus Rennó de Campos,
  • Maria Izaura Sedoguti Scudeler Agnollitto,
  • Carlos Henrique Miranda,
  • Antonio Pazin-Filho

摘要

Background

Integrating palliative care (PC) into emergency departments (EDs) is increasingly recognized as a strategy to support decision-making and avoid non-beneficial interventions near the end of life. However, evidence remains limited regarding its association with cardiopulmonary resuscitation (CPR) decisions in patients with poor prognosis.

Methods

We conducted a retrospective cohort study at a tertiary emergency hospital in Brazil, including adult inpatients who died between 2014 and 2024. The primary outcome was the occurrence of CPR during hospitalization. Patients were classified based on whether they received a PC consultation. Time to CPR was analyzed using Cox proportional hazards models adjusted for age, sex, comorbidities, and admission year. CPR attempts were identified using a validated natural language processing (NLP) approach applied to electronic health records (EHRs), with a Kappa agreement of 0.70 (95% CI: 0.61–0.79) compared to manual chart review.

Results

Among 6,211 patients, 1,757 (28.5%) received a PC consultation before death. PC consultation was independently associated with a lower likelihood of CPR, with an adjusted hazard ratio (HR) of 0.35 (95% CI: 0.32–0.39; p < 0.001). In a sensitivity analysis limited to patients who died within 24 hours of admission, the association remained significant (HR: 0.26; 95% CI: 0.18–0.37; p < 0.001).

Conclusions

In this cohort of hospitalized patients who died, palliative care consultation before any CPR attempt was associated with lower rates of CPR, possibly reflecting earlier or more thorough discussions of treatment preferences.