Background: Emergency departments (ED) serve as a contact point for critically ill patients. According to experience, a fraction of patients visiting ED present with symptoms and require palliative care; however, the prevalence of these patients has not been determined in Peru so far. Objectives: To estimate the prevalence of advanced disease in patients admitted to ED and identify among them the need for palliative care. Patients and methods: In the ED of 3 tertiary hospitals in Lima all adult patients had an evaluation of the medical history and an interview with patients or caregivers. The presence of multiple metastases was considered advanced cancer, and dementia, neurological, respiratory, hepatic or cardiac disease with functional dependence or severe deterioration for non-oncological illness. The screening tool was a validated and adapted palliative care questionnaire. Results: The prevalence of advanced illness was 7.5% (60 of 797 admissions). The age of patients was 19–96 (median 73.1) years of which 48.3% were females, 23 (39%) patients had oncological and 37 (61%) patients non-oncological diagnoses. The most frequent symptoms upon admission were dyspnoea, drowsiness, and pain. A total of 13 (21.7%) of patients with advanced disease were already receiving palliative care and 8 (13.3%) had controlled symptoms. Conclusions: Nearly 1 in 13 patients attending ED of tertiary hospitals has advanced disease, of which 80% reported the need for palliative care with less than a quarter of them having received it.