164 Utility of the "Surprise Question" in Critically Ill Emergency Department Patients

Glick, Joshua; B, Gallo Marin; Chelluri, Jayaram; Courtright, Katherine R.

doi:10.1016/j.annemergmed.2018.08.169

Cited by 3 publications

(22 citation statements)

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“…Thirteen studies were assessed using the STARD and QUADAS tools 4,13,15,19,27‐29,37,41‐45 . Based on the STARD criteria, the majority of studies clearly reported assessing the methods for participant sampling, the reference standard, the patient characteristics, and the tools clinical applicability (see Appendix 3).…”

Section: Resultsmentioning

confidence: 99%

“…13 While the evidence suggests that the SPEED 43 and P-CaRES The proportion of patients identified as having unmet PC needs varied considerably across the included studies, even among studies using the same screening tools, which could be the result of many factors. First, the patient population that was screened for unmet PC needs varied, with some studies screening only patients 65 years or older, 4,44 while other studies specifically screened patients who were admitted to hospital or the ICU 18,19,27 or any patients with specific clinical conditions 29,45 or specifically patients with established EOL conditions. 28,30,35 As previously mentioned, the performance of the SQ to predict mortality appears to decrease among patients with non-cancer-related conditions, 47 and at this point, it is unclear whether other patient demographic or clinical characteristics impacted the performance of the other PC screening tools.…”

Section: Discussionmentioning

confidence: 99%

“…The overall median PPV of the SQ was 32% (IQR 16%-40%) while the median NPV was 91% (IQR 88%-95%). The sensitivity of the SQ to predict patient mortality at 30 days was lower (range 12%-43%) 27,29,42 than at 12 months (range 57%-89%; 4,19,28,44,45 see Figure 2). Similarly, the specificity of the SQ was higher among studies assessing patient mortality at 30 days (range 82%-95%) 27,29,42 than at 12 months (range 40%-79%).…”

Section: Performancementioning

confidence: 96%

“…Twelve of the included studies were conference abstracts. [15][16][17][18][19][20][21][22][23][24][25][26] The majority of studies reported screening unmet PC needs in ED patients with specific EOL conditions or patients requiring admission (see Table 1). 12,13,[15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Across the 35 included studies, a total of 14 unique screening tools were assessed (see Table 1 and Appendix 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…While most of the included studies applied the original SQ (Would you be surprised if the patient died in the next 12 months? ), 4,16,19,28,44,45 some studies utilized a modified SQ (Would you be surprised if the patient died in the next 30 days?). 15,17,18,27,29,42 A negative response (e.g., the physician would not be surprised if the patient died during a given time frame) was suggestive that the patient had unmet PC needs.…”

Section: Sqmentioning

confidence: 99%

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Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Kirkland

Yang

Clua

et al. 2022

Academic Emergency Medicine

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Objectives This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED). Methods A comprehensive search of electronic databases and the gray literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction, and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQRs). Results A total of 35 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n = 12 studies), followed by the Palliative Care and Rapid Emergency Screening (P‐CaRES) tool (n = 8), and the screening for palliative and end‐of‐life care needs in the emergency department (SPEED) instrument (n = 4). Twelve of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (63%, IQR 38%–78%) and specificity (75%, IQR 57%–84%) of the SQ to predict mortality at 1 or 12 months was moderate. While the median positive predictive value of the SQ was low (32%, IQR 16%–40%), the median negative predictive value was high (91%, IQR 88%–95%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%. Conclusions This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Performancementioning

confidence: 96%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Sqmentioning

confidence: 99%

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Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Kirkland

Yang

Clua

et al. 2022

Academic Emergency Medicine

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Best Practices in End of Life and Palliative Care in the Emergency Department

Prachanukool

George

Bowman

et al. 2023

Clinics in Geriatric Medicine

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The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis

et al. 2022

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Background: The surprise question is widely used to identify patients nearing the last phase of life. Potential differences in accuracy between timeframe, patient subgroups and type of healthcare professionals answering the surprise question have been suggested. Recent studies might give new insights. Aim: To determine the accuracy of the surprise question in predicting death, differentiating by timeframe, patient subgroup and by type of healthcare professional. Design: Systematic review and meta-analysis. Data sources: Electronic databases PubMed, Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched from inception till 22nd January 2021. Studies were eligible if they used the surprise question prospectively and assessed mortality. Sensitivity, specificity, negative predictive value, positive predictive value and c-statistic were calculated. Results: Fifty-nine studies met the inclusion criteria, including 88.268 assessments. The meta-analysis resulted in an estimated sensitivity of 71.4% (95% CI [66.3–76.4]) and specificity of 74.0% (95% CI [69.3–78.6]). The negative predictive value varied from 98.0% (95% CI [97.7–98.3]) to 88.6% (95% CI [87.1–90.0]) with a mortality rate of 5% and 25% respectively. The positive predictive value varied from 12.6% (95% CI [11.0–14.2]) with a mortality rate of 5% to 47.8% (95% CI [44.2–51.3]) with a mortality rate of 25%. Seven studies provided detailed information on different healthcare professionals answering the surprise question. Conclusion: We found overall reasonable test characteristics for the surprise question. Additionally, this study showed notable differences in performance within patient subgroups. However, we did not find an indication of notable differences between timeframe and healthcare professionals.

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164 Utility of the "Surprise Question" in Critically Ill Emergency Department Patients

Cited by 3 publications

References 0 publications

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

Best Practices in End of Life and Palliative Care in the Emergency Department

The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis

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