How Well Does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD?
J Gen Intern Med
; 36(9): 2656-2662, 2021 09.
Article
en En
| MEDLINE
| ID: mdl-33409886
ABSTRACT
BACKGROUND:
Patients with chronic obstructive pulmonary disease (COPD) often receive burdensome care at end-of-life (EOL) and infrequently complete advance care planning (ACP). The surprise question (SQ) is a prognostic tool that may facilitate ACP.OBJECTIVE:
To assess how well the SQ predicts mortality and prompts ACP for COPD patients.DESIGN:
Retrospective cohort study.SUBJECTS:
Patients admitted to the hospital for an acute exacerbation of COPD between July 2015 and September 2018. MAINMEASURES:
Emergency department (ED) and inpatient clinicians answered, "Would you be surprised if this patient died in the next 30 days (ED)/one year (inpatient)?" The primary outcome measure was the accuracy of the SQ in predicting 30-day and 1-year mortality. The secondary outcome was the correlation between SQ and ACP (palliative care consultation, documented goals-of-care conversation, change in code status, or completion of ACP document). KEYRESULTS:
The 30-day SQ had a high specificity but low sensitivity for predicting 30-day mortality sensitivity 12%, specificity 95%, PPV 11%, and NPV 96%. The 1-year SQ demonstrated better accuracy for predicting 1-year mortality sensitivity 47%, specificity 75%, PPV 35%, and NPV 83%. After multivariable adjustment for age, sex, and prior 6-month admissions, 1-year SQ+ responses were associated with greater odds of 1-year mortality (OR 2.38, 95% CI 1.39-4.08) versus SQ-. One-year SQ+ patients were more likely to have a goals-of-care conversation (25% vs. 11%, p < 0.01) and complete an advance directive or POLST (46% vs. 23%, p < 0.01). After multivariable adjustment, SQ+ responses to the 1-year SQ were associated with greater odds of ACP receipt (OR 2.67, 95% CI 1.64-4.36).CONCLUSIONS:
The 1-year surprise question may be an effective component of prognostication and advance care planning for COPD patients in the inpatient setting.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Enfermedad Pulmonar Obstructiva Crónica
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Planificación Anticipada de Atención
Tipo de estudio:
Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Gen Intern Med
Asunto de la revista:
MEDICINA INTERNA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos