Table 1.
| Physical Signs | Frequency of sign in last 3 days of life, %* | Median Onset in days (Q1–Q3)† | Sensitivity‡ (95% CI) | Specificity‡ (95% CI) | Negative Likelihood Ratio‡ (95% CI) | Positive Likelihood Ratio‡ (95% CI) |
|---|---|---|---|---|---|---|
| Palliative performance scale ≤20% | 93 | 4.0 (3.5–6.0) | 64 (63.4–64.7) | 81.3 (80.9–81.7) | 0.44 (0.43–0.45) | 3.5 (3.4–3.6) |
| Richmond Agitation Sedation Scale ≤−2 | 90 | 4.5 (3–6) | 50.5 (49.9–51.1) | 89.3 (88.9–89.7) | 0.6 (0.5–0.6) | 4.9 (4.7–5) |
| Urine output over last 12 h <100 ml | 72 | 1.5 (1.0–2.5) | 24.2 (23.2–25.1) | 98.2 (98–98.5) | 0.77 (0.76–0.78) | 15.2 (13.4–17.1) |
| Death rattle | 66 | 1.5 (1.0–2.0) | 22.4 (21.8–22.9) | 97.1 (96.9–97.3) | 0.8 (0.79–0.81) | 9 (8.1–9.8) |
| Respiration with mandibular movement | 56 | 1.5 (1.0–2.0) | 22 (21.5–22.4) | 97.5 (97.3–97.6) | 0.8 (0.8–0.81) | 10 (9.1–10.9) |
| Peripheral cyanosis | 59 | 3.0 (2.0–4.5) | 26.7 (26.1–27.3) | 94.9 (94.7–95.2) | 0.77 (0.77–0.78) | 5.7 (5.4–6.1) |
| Cheyne Stokes breathing | 41 | 2.0 (1.0–2.0) | 14.1 (13.6–14.5) | 98.5 (98.4–98.7) | 0.9 (0.9–0.9) | 12.4 (10.8–13.9) |
| Pulselessness of radial artery | 38 | 1.0 (0.5–1.0) | 11.3 (10.9–11.8) | 99.3 (99.2–99.5) | 0.89 (0.89–0.9) | 15.6 (13.7–17.4) |
| Decreased response to verbal stimuli | 69 | 2.0 (1.5–4.0) | 30 (29.4–30.5) | 96 (95.8–96.3) | 0.73 (0.72–0.74) | 8.3 (7.7–9) |
| Decreased response to visual stimuli | 70 | 3.0 (2.0–4.0) | 31.9 (31.4–32.4) | 94.9 (94.6–95.1) | 0.72 (0.71–0.72) | 6.7 (6.3–7.1) |
| Non-reactive pupils | 38 | 2.0 (1.5–3.0) | 15.3 (14.9–15.7) | 99 (98.8–99.1) | 0.86 (0.85–0.86) | 16.7 (14.9–18.6) |
| Drooping of nasolabial fold | 78 | 2.5 (1.5–3.0) | 33.7 (33.2–34.3) | 95.5 (95.3–95.8) | 0.69 (0.69–0.7) | 8.3 (7.7–8.9) |
| Hyperextension of neck | 46 | 2.5 (2.0–3.0) | 21.2 (20.6–21.7) | 96.7 (96.5–96.9) | 0.82 (0.81–0.82) | 7.3 (6.7–8) |
| Inability to close eyelids | 57 | 1.5 (1.0–1.5) | 21.4 (20.9–21.8) | 97.9 (97.7–98.1) | 0.8 (0.8–0.81) | 13.6 (11.7–15.5) |
| Grunting of vocal cords | 54 | 1.5 (1.0–2.0) | 19.5 (19–19.9) | 97.9 (97.7–98.1) | 0.82 (0.82–0.83) | 11.8 (10.3–13.4) |
| Upper gastrointestinal bleed | 5 | 5.5 (0.5–17.0) | 2.9 (2.8–3) | 99.7 (99.6–99.7) | 0.97 (0.97–0.98) | 10.3 (9.5–11.1) |
any occurrence of the sign of interest within the last 3 days of life among patients who died in the APCU
median onset from death backwards (in days)
we computed the sensitivity, specificity, positive likelihood ratio (LR), and negative LR for each sign for death within 3 days using data from all 357 patients. We constructed a 2×2 table with one observation per patient based on the presence or absence of a particular sign during a randomly sampled nursing shift and whether that patient died within the next 3 days from that shift (i.e. gold standard), and then calculated the sensitivity, specificity, positive LR and negative LR. To account for the multiple observations for each patient, we re-sampled our data 100x to obtain the average and 95% confidence interval for each statistic
Abbreviations: CI, confidence interval; Q1–Q3, interquartile range