A simple bedside test could help doctors determine whether a patient is likely to die within the next 24 hours, according to new research published in the BMJ Supportive and Palliative Care journal. The study, led by Dr Jung Hun Kang of Gyeongsang National University Hospital, suggests that the absence of the corneal reflex is a strong predictor of imminent death.
The corneal reflex, an involuntary blink in response to touch on the cornea, was monitored three times daily in 112 hospice residents with advanced cancer. Nurses gently touched the cornea with a sterile cotton wisp and recorded responses as intact, diminished, or absent. Of the participants, 110 died within seven days of the study starting.
Patients with no corneal reflex were five times more likely to die within 24 hours compared to those with intact or diminished reflexes. The 24-hour mortality rate among those without the reflex was 70.7 per cent, and the test was found to be 95 per cent accurate.
Dr Kang said: “Absence of the reflex may strongly support a prediction of imminent death, but preservation of the reflex does not rule it out. Loss of the corneal reflex may reflect progressive deterioration of brainstem function as part of the natural dying process.”
A multi-centre follow-up study in a more diverse population is planned, and Kang hopes artificial intelligence could help detect subtle patterns in corneal reflex that might be missed by bedside clinicians.
“Improving care in the final hours of life is just as important as prolonging survival,” Kang added. “The better we become at recognising imminent death, the better we can support a more peaceful and dignified experience for patients and families.”
