Five signs of impending death
Padma Shri Awardee
Vice President CMAAO
President HCFI
Clinical signs of impending death
A prospective multi-institutional study reported in Oncologist. 2014;19:681 documented the presence or absence of 10 physical signs every 12 hours from admission to death or discharge for 357 patients with advanced cancer who were admitted to two palliative care units
Five of the signs (high positive LRs, were pulselessness of the radial artery, respiration with mandibular movement, decreased urine output, Cheyne-Stoke breathing and death rattle) that emerged mostly during the last three days of life had both high specificity (i.e., >95% chances that the patient would not die within three days, if the symptom was absent) (listen: ">
However, sensitivity was limited; these signs were present in fewer than 27% of the patients who died. Thus, clinicians and families cannot rely on vital signs alone to rule in or rule out impending death, and routine monitoring of the vital signs in patients who are imminently dying cannot be recommended.
(Newsletter)
