SPICT tool among intubated elderly patients at emergency department

The global rise in the aging population necessitates a proactive approach to palliative care, with a substantial gap between the demand for and access to such care. The Supportive and Palliative Care Indicators Tool (SPICT) has emerged as a valuable instrument for identifying patients at risk of deterioration and death, enhancing the timely initiation of palliative care. This study aimed to investigate the characteristics and outcomes of patients aged 60 and above who got intubated in the emergency department (ED), with and without fulfilling SPICT criteria.

This retrospective single-center study was conducted at a tertiary care teaching hospital in Thailand. The research involved 408 adults aged 60 and older who underwent ED intubation and subsequent admission. Baseline characteristics and follow-up data were collected, encompassing vital signs, comorbidities, and SPICT criteria. Mortality rates between SPICT criteria-fulfilled and non-fulfilled groups were compared.

Out of 408 analyzed patients, SPICT criteria were met by 39.7 % of patients, exhibiting distinctive features such as a higher respiratory rate and lower diastolic blood pressure. Hypertension and diabetes mellitus were most prevalent comorbidities. Respiratory and neurological disorders were the leading final diagnoses. The overall in-hospital mortality rate was 28 %, significantly higher in the SPICT criteria-fulfilled group compared to the non-fulfilled group (34.0 % vs 23.6 %, P = 0.022). SPICT criteria demonstrated moderate sensitivity (48.7 %) and specificity (63.7 %) for predicting mortality.

SPICT criteria identified elderly patients at an elevated mortality risk following intubation in the emergency setting. The early implementation of SPICT as a screening tool for identifying palliative care candidates is advocated for more effective advance care planning.