A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life

Am J Hosp Palliat Care. 2013 Sep;30(6):601-16. doi: 10.1177/1049909112468222. Epub 2012 Dec 12.


To optimally manage patient care, knowledge of the prevalence of signs of impending death and common symptoms in the last days is needed. Two reviewers independently conducted searches of PubMed, CINAHL, PsychINFO and the Web of Knowledge from January, 1996 to May, 2012. No limits to publication language or patient diagnosis were imposed. Peer reviewed studies of adults that included contemporaneous documentation of signs and symptoms were included. Articles were excluded if they assessed symptoms by proxy or did not provide information on prevalence. Reviewers independently extracted data. Twelve articles, representing 2416 patients, in multiple settings were analyzed. Of the 43 unique symptoms, those with the highest prevalence were: dyspnea (56.7%), pain (52.4%), respiratory secretions/death rattle (51.4%), and confusion (50.1%). Overall prevalence may be useful in anticipating symptoms in the final days and in preparing families for signs of impending death.

Keywords: dying; end of life; signs of impending death; symptom management; symptom prevalence; symptoms.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Confusion / epidemiology
  • Critical Illness*
  • Death*
  • Dyspnea / epidemiology
  • Humans
  • Pain / epidemiology
  • Prevalence
  • Terminal Care