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Objectives: A growing number of patients die each year in hospital emergency departments (EDs). Decisions to withhold or to withdraw life-support therapies occur in 80% of patients as described in a multicentre cross-sectional survey including 2420 patients. Palliative care has not been explored in patients dying in this setting. The aim of this study was to assess the incidence of palliative care and to describe this population., Methods: The authors conducted a post-hoc analysis on a cohort of 2420 patients who died in 174 French and Belgian EDs. The authors identified patients who benefited from palliative care and described this population and the palliative care., Results: Palliative therapies were administered to 1373 patients (56.7%). These therapies included administration of analgesics, sedation, mouth care, repositioning for comfort (as appropriate) and provision of emotional support to the patient and his/her relatives. These palliative measures were provided more frequently in the observation unit of the ED (n=908, 66.2%) than in an examination room (n=465, 33.8%). Median time interval between ED admission and death was longer in patients who received palliative care (n=1373) (median, 15 h; first quartile, 6 h; third quartile, 34 h) than in those who did not (n=1047) (median, 4 h; first quartile, 1 h; third quartile, 10 h) (p<10(-4))., Conclusions: Palliative care is administered to about half of the patients who die in EDs. This is insufficient as the majority of the patients who died in EDs actually died after a decision to withhold or withdraw life-support therapies. End-of-life management must be improved in EDs.

Objective: In France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke., Methods: We conducted a post hoc analysis to identify potential organ donors with cardiac function among a population of dying patients in emergency departments. This population had been selected for a separate multicenter prospective observational study. We identified patients who died of a neurologic cause but had no clinical findings affecting their donor status., Results: Of 2420 patients in the study, 407 died of a neurologic cause; and 233 of these were excluded because of clinical factors that made them ineligible as organ donors. The remaining 174 patients (7.2% of dying patients) could be considered potential organ donors. Their mean age was 75.2 ± 11 years. Sixty-eight (39%) were intubated, and 60 of these (34.5%) were mechanically ventilated. In addition, 94 patients (54%) died within 12 hours (median, 9.3 hours) after admission; and 13 (7%) died while receiving a maximum level of care. No diagnostic procedures were performed to assess brain death., Conclusion: A significant number of patients who die in emergency departments could be organ donors, including approximately 7% between 60 and 85 years of age with life-threatening neurologic diseases. However, this percentage may be reduced by family opposition. Emergency physicians should collaborate with intensive care units and local organ donation teams to optimize end-of-life care and maximize the number of potential donors., (Copyright © 2012 Elsevier Inc. All rights reserved.)