Authors (including presenting author) :
Lai BK(1), Kong TYK(1), Kwong MC(1), Law TL(1), Ng LY(1)
Affiliation :
(1) Palliative Care Team, Central Nursing Division, Queen Elizabeth Hospital, Hospital Authority, Hong Kong
Keyword 1: :
Clinical Diagnostic Model
Keyword 3: :
Prognostication
Keyword 4: :
Terminally ill
Introduction :
In acute care settings, many patients are approaching the end of life, emphasizing the need to recognize and manage dying signs effectively. However, variability in palliative care training among nurses often leads to inconsistent identification of the dying process, potentially compromising care quality. Although several prognostic tools support recognition of imminent death (Simmons et al., 2017), their effectiveness and use remain inconsistent among healthcare professionals. Providing high-quality end-of-life care requires both clinical expertise and compassionate support for patients and families. This study builds on existing research linking specific dying signs to impending death. It aims to examine the relationship between commonly observed dying signs and mortality within one week. To enhance clinical practice, a diagnostic model will be developed by integrating the Palliative Performance Scale (PPS) with identified dying signs to improve imminent death prognostication. This model is expected to strengthen nurses’ ability to recognize imminent death early, thereby facilitating timely and holistic end-of-life care in acute hospitals (Baik et al., 2018; Lawton et al., 2014).
Objectives :
•To observe the occurrence and frequency of common dying signs among patients in acute care settings during the last seven days of life. •To evaluate the Palliative Performance Scale (PPS) scores of patients in acute care settings during the last seven days of life. •To determine the correlation between specific dying signs and PPS scores. •To assess whether combining PPS scores with observed dying signs enhances the prediction accuracy for imminent death (within one week) compared with using PPS alone. •To develop and propose a refined prognostic model or tool based on the integrated findings.
Methodology :
This retrospective cohort study reviewed medical records of 200 adult patients who died at QEH from 1 October 2024 to 21 August 2025, selected via consecutive sampling with documented Palliative Performance Scale (PPS) scores and at least 1 of 15 dying signs in the final 7 days pre-death. We examined the frequency and median onset of each sign from death backward and their likelihood ratios (LRs) associated with death within 3 to 5 days. The correlation between the number of dying signs combined with PPS ≤20% versus survival time is evaluated.
Result & Outcome :
This analysis evaluated the prognostic performance of a clinical signs scoring system for predicting 3 and 5-day mortality. For 3 signs (last 5/3 days): sensitivity 73.47%/77.18%, specificity 40.48%/37.50%, +LR 1.23/1.23, accuracy 67.23%/60.02%; for 4 signs: sensitivity 53.89%/61.11%, specificity 67.26%/64.84%, +LR 1.65/1.74, accuracy 56.42%/62.73%. In addition, PPS ≤20% appeared in 93.0% of cases (high sensitivity 86.8%, low specificity 16.4%). Diagnostic test accuracy analysis of the 15 study dying signs identified 10 with high specificity (>90%) for imminent death: Cheyne-Stokes Breathing (98.7%), Death Rattle (99.2%), Drooping of Nasolabial folds (99.21%),Decreased Urine Output (96.1%), Peripheral Cyanosis (96.9%), Apnea (96.1%), Respiration with Mandibular Movement (95.8%), Inability to Close Eyelids (95.0%), and Radial Pulselessness (92.9%), Altered body temperature( and Neck Hypertension (90.3%)though their low frequencies (7–23%) favor confirmatory over screening use
