TOPLINE

Among 250 patients presenting to the emergency department (ED) with dyspnea at the end of life, 15.2% received morphine in the ED, whereas 68% received it during subsequent inpatient care. Patients with lung cancer or a do-not-resuscitate order were more likely to receive morphine in the ED, but its use was not associated with reduced survival.

METHODOLOGY

• A retrospective cohort study included 250 adults who presented to an ED in Israel with dyspnea between 2023 and 2024 and died during the same hospitalization (mean age, 83.2 years; 51.2% women; 91.5% Jewish individuals). Common underlying conditions included congestive heart failure, chronic obstructive pulmonary disease, and metastatic cancer.
• Researchers assessed the proportion of patients receiving morphine in the ED and during the hospital stay.
• Investigators evaluated the time to morphine administration, the respiratory support provided, and how long patients lived after arriving at the ED.
• Predictors of ED morphine administration were identified using multivariable logistic regression.

TAKEAWAY

• Morphine was administered to 15.2% of patients in the ED but to 68% during inpatient care; among those treated in the ED, the average time to morphine administration was 5.8 hours.
• Three factors independently predicted the use of morphine in the ED: lung cancer (odds ratio [OR], 3.41; P = .022), a do-not-resuscitate/do-not-intubate order (OR, 3.17; P = .010), and higher pulse rate at arrival (OR, 1.022 per beat increase; P = .008).
• Morphine administration in the ED was not associated with time to death. Patients who received morphine during inpatient care had a longer observed mean survival than those who did not (282.2 vs 152.4 hours; P < .001); however, this comparison was subject to immortal time bias.

IN PRACTICE

"Clinician education, department-level symptom-management protocols, and earlier integration of palliative care into the emergency department are needed so that relief of breathlessness begins where the patient first presents," the authors wrote.

SOURCE

The study was led by Asher Taragin, MD, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, Hebrew University of Jerusalem, in Jerusalem, Israel. It was published online on September 24, 2026, in the Journal of Pain and Symptom Management.

LIMITATIONS

The study was retrospective and conducted at a single center; only 38 patients received morphine in the ED, which limited statistical power. Dyspnea was identified from clinical notes rather than validated severity scales, patient-reported outcomes were not assessed, and adverse events were not reliably recorded. Patients were identified as being at the end of life only after they died, so ED clinicians may not have recognized that they were dying. Survival comparisons for inpatient morphine were affected by immortal time bias, which may have influenced the findings.  

DISCLOSURES

The study received no funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.