Early Detection of Palliative Care Needs in Critically Ill Patients Using the NECPAL Tool

Background: Palliative care is essential in intensive care, improving symptom control, quality of life, and reducing hospital stays without increasing mortality. However, early identification of patients who could benefit remains a major challenge. This study aimed to evaluate the NECesidades PALiativas (NECPAL) tool's effectiveness in identifying ICU patients in Italy with PC needs. Methods: This prospective observational study was conducted from March 2024 to February 2025. Adult ICU patients (≥18 years), admitted for at least 24 h and meeting NECPAL eligibility criteria (e.g., cancer, COPD, heart failure, dementia, and frailty), were evaluated using the NECPAL tool. Results: A total of 85 patients were enrolled; 28 (32.9%) were classified as NECPAL-positive and 57 (67.1%) as NECPAL-negative. NECPAL-positive patients had a significantly higher ICU mortality rate (32.1%) compared to NECPAL-negative patients (1.8%) (p < 0.001). The median ICU length of stay was slightly longer for NECPAL-positive patients [11.0 days (IQR: 8.0-16.2)] versus NECPAL-negative patients [10.0 days (IQR: 5.0-14.0)], though not statistically significant. Multivariable Firth penalized logistic regression confirmed NECPAL positivity as an independent predictor of ICU mortality (OR 19.55; 95% CI: 3.06-124.93; p < 0.001). Conclusions: In this study, NECPAL identified about one-third of ICU patients as having palliative care needs, who also showed a higher mortality risk. Integration with ICU severity scores may improve early recognition of these needs, warranting validation in larger multicenter studies.