Feyi Kennedy, Klinger Sarah, Pharro Georgina, Mcnally Liz, James Ajith, Gretton Kate, Almond Michael K
Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
Department of Palliative Medicine, Southend University Hospital, Southend, Essex, UK.
BMJ Support Palliat Care. 2015 Mar;5(1):19-25. doi: 10.1136/bmjspcare-2011-000165. Epub 2013 Mar 12.
The Gold Standard Frameworks (GSF) Committee devised Prognostic Indicator Guidance in November 2007 to 'aid identification of adult patients with advanced disease, in the last months or year of life, who are in need of supportive or palliative care'.
This research used the GSF `surprise question' to formulate a list of patients predicted to die within 1 year with end stage renal failure and to establish the specificity and sensitivity of this register.
58 patients were added to the list during the follow-up period of which 28 (48.3%) died during the same period giving an annual mortality of 32.2%. In comparison with the patients who died during the follow-up period but were not added to the at-risk register, those on the register had a much higher mortality rate (32.2% vs 7.8%). Identification of patients with chronic kidney disease and reduced life expectancy by this method appears to have a high sensitivity (66.7%) and specificity (77.9%). In particular, the negative predictive value for mortality for those on the at-risk register appears to be very high (88.3%), indicating the very low mortality among those not on the register.
Patients with chronic kidney disease and a reduced life expectancy can be accurately identified by a multi-disciplinary team using the surprise trigger question with a relatively high sensitivity and specificity. The accurate identification of patients with reduced life expectancy allows appropriate end of life care planning to begin in keeping with patients' wishes and within published guidelines.
金标准框架（GSF）委员会于2007年11月制定了预后指标指南，以“帮助识别患有晚期疾病、处于生命最后几个月或一年、需要支持性或姑息性护理的成年患者”。
本研究使用GSF的“意外问题”来制定一份预计在1年内死于终末期肾衰竭的患者名单，并确定该登记册的特异性和敏感性。
在随访期间有58名患者被列入名单，其中28名（48.3%）在同一时期死亡，年死亡率为32.2%。与随访期间死亡但未被列入风险登记册的患者相比，登记册上的患者死亡率要高得多（32.2%对7.8%）。通过这种方法识别慢性肾病和预期寿命缩短的患者似乎具有较高的敏感性（66.7%）和特异性（77.9%）。特别是，风险登记册上患者的死亡阴性预测值似乎非常高（88.3%），这表明未列入登记册的患者死亡率极低。
多学科团队使用意外触发问题能够以相对较高的敏感性和特异性准确识别慢性肾病且预期寿命缩短的患者。准确识别预期寿命缩短的患者有助于根据患者意愿并在已发布的指南范围内开始适当的临终护理规划。
