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Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure
Published on: June 30, 2023
High specificity clinical signs of impending death: A scoping review
Catarina Simões1, Rui Carneiro2, Abílio CardosoTeixeira3
1Escola Superior de Saúde de Santa Maria Porto, Portugal; Hospital da Luz Arrábida Porto, Portugal; Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa Porto, Portugal.
Background:
Accurate diagnosis of impending death is essential to provide proper care in the last days and hours of life. Recognising the death situation immediately allows adjustment of care goals, ensuring that they suit the patient's condition, as well as tuning the team's and family's expectations.
Objective:
To map and describe evidence on high specificity clinical signs of impending death in cancer and noncancer hospitalised patients over 18 years of age.
Methods:
A comprehensive search of the published literature was conducted According to Joanna Briggs Institute's methodology for scoping reviews. Online databases, including MEDLINE, CINAHL complete, SCOPUS, WEB OF SCIENCE, and the Cochrane Database of Systematic Reviews, and the search for unpublished studies included OpenGrey, DART-Europe, and RCAAP. Publications in English, French, Portuguese, and Spanish were included, and no period was set. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions to scoping review guidelines were used to report the results. The review protocol was registered in Open Science Framework (Simões et al., 2022).
Results:
The 15 studies included in this review were published in English between 2013 and 2023. In addition to identifying the clinical signs of impending death, some researchers intend to develop accurate prognostic models for this clinical situation. Only two studies in the noncancer population met the inclusion criteria. Twelve articles were prospective observational studies (seven were multicentre studies), one was a retrospective cohort study, and two were narrative reviews. A clinical sign that is common to studies in both populations is respiration with mandibular movement, particularly in the last 12 h of life.
Conclusions:
Clinical signs of impending death and prediction models can help clinicians identify impending death. However, they should not replace clinical judgement. Further research is required to understand whether the dying process differs among different patient populations and care settings.
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