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 English
| WPRIM
| ID: wpr-785588
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Palliative Care
/
Terminal Care
/
Logistic Models
/
Sensitivity and Specificity
/
Hospital Mortality
/
Emergencies
/
Emergency Service, Hospital
/
Observational Study
/
Palliative Medicine
/
Intensive Care Units
Type of study:
Diagnostic study
/
Etiology study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Language:
English
Journal:
Clinical and Experimental Emergency Medicine
Year:
2019
Type:
Article
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