Prognostic value of a modified surprise question designed for use in the emergency department setting
Clinical and Experimental Emergency Medicine
; (4): 70-76, 2019.
Article
in En
| WPRIM
| ID: wpr-785588
Responsible library:
WPRO
ABSTRACT
OBJECTIVE:
Few reliable and valid prognostic tools are available to help emergency physicians identify patients who might benefit from early palliative approaches. We sought to determine if responses to a modified version of the surprise question, “Would you be surprised if this patient died in the next 30 days” could predict in-hospital mortality and resource utilization for hospitalized emergency department patients.METHODS:
For this observational study, emergency physicians responded to the modified surprise question with each admission over a five-month study period. Logistic regression analyses were completed and standard test characteristics evaluated.RESULTS:
6,122 visits were evaluated. Emergency physicians responded negatively to the modified surprise question in 918 (15.1%). Test characteristics for in-hospital mortality were sensitivity 32%, specificity 85%, positive predictive value 6%, negative predictive value 98%. The risk of intensive care unit use (relative risk [RR], 1.87; 95% confidence interval [CI], 1.45 to 2.40), use of ‘comfort measures’ orders (RR, 3.43; 95% CI, 2.81 to 4.18), palliative-care consultation (RR, 3.06; 95% CI, 2.62 to 3.56), and in-hospital mortality (RR, 2.18; 95% CI, 1.72 to 2.76) were greater for patients with negative responses.CONCLUSION:
The modified surprise question is a simple trigger for palliative care needs, accurately identifying those at greater risk for in-hospital mortality and resource utilization. With a negative predictive value of 98%, affirmative responses to the modified surprise question provide reassurance that in-hospital death is unlikely.Key words
Full text:
1
Index:
WPRIM
Main subject:
Palliative Care
/
Terminal Care
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Logistic Models
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Sensitivity and Specificity
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Hospital Mortality
/
Emergencies
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Emergency Service, Hospital
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Observational Study
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Palliative Medicine
/
Intensive Care Units
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Clinical and Experimental Emergency Medicine
Year:
2019
Type:
Article