"Triple Threat" Conditions Predict Mortality Among Patients With Advanced Cancer Who Present to the Emergency Department

Background: Delirium, poor performance status, and dyspnea predict short survival in the palliative care setting. Objective: Our goal was to determine whether these three conditions, which we refer to as a “triple threat,” also predict mortality among patients with advanced cancers in the emergency department (ED). Methods: The study sample included 243 randomly selected, clinically stable patients with advanced cancer who presented to our ED. The analysis included patients who had delirium (Memorial Delirium Assessment Scale score ≥ 7), poor performance status (Eastern Cooperative Oncology Group performance status score of 3 or 4), or dyspnea as a presenting symptom. We obtained survival data from medical records. We calculated predicted probability of dying within 30 days and association with number of symptoms after the ED visit using logistic regression analysis. Results: Twenty-eight patients died within 30 days after presenting to the ED. Death within 30 days occurred in 36% (16 of 44) of patients with delirium, 28% (17 of 61) of patients with poor performance status, and 14% (7 of 50) of patients with dyspnea, with a predicted probability of 30-day mortality of 0.38 (95% confidence interval [CI] 0.25–0.53), 0.28 (95% CI 0.18–0.40), and 0.15 (95% CI 0.07–0.29), respectively. The predicted probability of death within 30 days for patients with two or three of the conditions was 0.49 (95% CI 0.34–0.66) vs. 0.05 (95% CI 0.02–0.09) for patients with none or one of the conditions. Conclusions: Patients with advanced cancers who present to the ED and have at least two triple threat conditions have a high probability of death within 30 days.