Prognostic value of the Surprise Question for one-year mortality in older patients: a prospective multicenter study in acute geriatric and cardiology units

Maes, H.; Noortgate, Nele Van Den; Brauwer, Isabelle De; Velghe, Anja; Desmedt, Marianne; Saint-Hubert, Marie de; Piers, Ruth

doi:10.1080/17843286.2020.1829869

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…In total 59 studies were included in the meta-analysis. 18,21 –78 The flowchart of the included studies can be found in Figure 1. Four studies consisted of multiple cohorts: three studies consisted of a derivation and a validation cohort 22,38,52 and one study consisted of two different patient subgroups.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…In this study, the primary endpoint is worsening disease rather than mortality owing to the differences in the clinical setting and the disease severity. 13 , 14 , 18 , 33 , 34 A meta-analysis analyzed the association between the Surprise Question and 6 to 18-month mortality and found that the pooled prognostic characteristics of sensitivity, specificity, and the area under the curve were 0.67, 0.80, and 0.81, respectively. 12 However, our results show that sensitivity was greater than specificity when nurses judge the likelihood of worsening disease, perhaps because medical providers are more cautious when judging death versus disease progression.…”

Section: Discussionmentioning

confidence: 99%

Usability of the Surprise Question by Nurses and Patients’ Families for Risk Stratification in Emergency Patients: A Prospective Cohort Study

Liu

et al. 2023

INQUIRY

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The Surprise Question is an effective tool to identify patients in need of palliative care. But it is unknown whether the Surprise Question can effectively predict adverse outcomes in Emergency patients. Therefor this study is to determine the utility of the modified Surprise Question for risk stratification in emergency patients. And assessed if the modified Surprise Question could be used by different healthcare personnel. Nurses and patients’ families were asked to respond as “Yes” or “No” to the modified Surprise Question for each patient. The outcome was resuscitation unit admission. Logistic regression was used to determine covariant significantly associated with resuscitation unit admission. The area under the curve for the second Surprise Question response by nurses was 0.620, which improved to 0.704 when the responses of nurses and patients’ families were in agreement. The clinical impression of nurses is a valuable tool to predict altered conditions for medium-acuity patients, and the diagnostic accuracy improves when responses of patients’ families and nurses agreed. The clinical impression of nurses is a valuable tool to predict altered conditions for medium-acuity patients, and the diagnostic accuracy improves when responses of patients’ families and nurses agreed.

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“…4,5 The available evidence on the Surprise Question in older hospitalized patients generated mixed results, in line with our results. 6,7 An explanation could be that the trajectory of functional decline at the end of life in especially frail older patients is less predictable compared to patients with organ failure or a terminal illness. Where too much false positives leads to unnecessary usage of care and possibly unnecessary fear or worries for patients and their caregivers, too much false negatives leads to a missed opportunity of improving their quality of life.…”

Section: Discussionmentioning

confidence: 99%

The Surprise Question in Older Hospitalized Patients: To Use or Not to Use?

Theunissen

Magdelijns

Janssen

et al. 2022

Journal of the American Medical Directors Association

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Prognostic value of the Surprise Question for one-year mortality in older patients: a prospective multicenter study in acute geriatric and cardiology units

Cited by 8 publications

References 28 publications

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

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

Usability of the Surprise Question by Nurses and Patients’ Families for Risk Stratification in Emergency Patients: A Prospective Cohort Study

The Surprise Question in Older Hospitalized Patients: To Use or Not to Use?

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