Comparison of Screening Tools among Supportive and Palliative Care Indicators Tool (SPICT), Modified Surprise Question and Palliative Care and Rapid Emergency Screening (P-CaRES) to Identify Palliative Care Needs in Emergency Department

IntroductionThe emergency department (ED) serves as a critical entry point for identifying patients with end-of-life needs. However, time and resource constraints make selecting appropriate screening tools challenging.ObjectivesTo compare the prognostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT), Modified Surprise Question (MSQ), and Palliative Care and Rapid Emergency Screening (P-CaRES) in predicting 3-month mortality and to evaluate the agreement between these three screening tools.MethodThis prospective cohort study included 281 participants. Predictive accuracy was analyzed using C-statistics and Adjusted Hazard Ratios (aHR), and survival rates were compared using Kaplan-Meier analysis.ResultsThe 3-month mortality rate was 56.23% (158 patients) . All three tools significantly predicted 3-month mortality (p<0.001). P-CaRES demonstrated the highest accuracy (C-statistic 0.666; 95% CI: 0.60–0.73) and identified the highest-risk group with the shortest median survival of 17 days (95% CI: 11.92–22.08). Meanwhile, MSQ yielded the highest aHR of 2.59 (95% CI: 1.78–3.76; p<0.001). The level of agreement among the three tools was fair, with the highest concordance found between SPICT and P-CaRES (kappa = 0.374; p<0.001). Conclusion The three screening tools demonstrated significant prognostic accuracy in predicting 3‑month mortality, with P-CaRES showing the highest overall accuracy, while MSQ yielded the highest adjusted hazard ratio for identifying high‑risk patients. The level of agreement among the three tools was fair.