Need for palliative care in patients admitted to emergency departments of three tertiary hospitals: evidence from a Latin-American city

Background: Emergency departments (ED) serve as a contact point for critically ill patients. According toexperience, a fraction of patients visiting ED present with symptoms and require palliative care; however,the prevalence of these patients has not been determined in Peru so far.Objectives: To estimate the prevalence of advanced disease in patients admitted to ED and identify amongthem the need for palliative care.Patients and methods: In the ED of 3 tertiary hospitals in Lima all adult patients had an evaluation ofthe medical history and an interview with patients or caregivers. The presence of multiple metastases wasconsidered advanced cancer, and dementia, neurological, respiratory, hepatic or cardiac disease with functionaldependence or severe deterioration for non-oncological illness. The screening tool was a validatedand adapted palliative care questionnaire.Results: The prevalence of advanced illness was 7.5% (60 of 797 admissions). The age of patients was19–96 (median 73.1) years of which 48.3% were females, 23 (39%) patients had oncological and 37 (61%)patients non-oncological diagnoses. The most frequent symptoms upon admission were dyspnoea, drowsiness,and pain. A total of 13 (21.7%) of patients with advanced disease were already receiving palliativecare and 8 (13.3%) had controlled symptoms.Conclusions: Nearly 1 in 13 patients attending ED of tertiary hospitals has advanced disease, of which80% reported the need for palliative care with less than a quarter of them having received it