Lilley Elizabeth J, Gemunden Sean A, Kristo Gentian, Changoor Navin, Scott John W, Rickerson Elizabeth, Shimizu Naomi, Salim Ali, Cooper Zara
1 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts.
2 Department of Surgery, Rutgers-Robert Wood Johnson Medical School , New Brunswick, New Jersey.
J Palliat Med. 2017 Apr;20(4):420-423. doi: 10.1089/jpm.2016.0313. Epub 2016 Nov 1.
The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown.
We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients.
This was a prospective cohort study.
SETTING/SUBJECTS: Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014.
Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data.
Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were "No, I would not be surprised" and 40% were "Yes, I would be surprised." A "No" response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]).
The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.
“意外问题”是一种经过验证的工具，用于识别一年内死亡风险增加的患者，因此这些患者可能从姑息治疗中获益。然而，其在外科手术中的效用尚不清楚。
我们试图确定“意外问题”是否能预测老年急诊普通外科患者的12个月死亡率。
这是一项前瞻性队列研究。
设置/研究对象：2014年1月至7月在一家三级医疗学术医院接受培训的第三年及以上的急诊普通外科主治医生和外科住院医生。
外科医生在评估年龄≥65岁、因急性外科疾病住院的患者后72小时内回答“意外问题”。从病历中提取患者数据，包括人口统计学和临床特征。通过使用社会保障死亡数据确定初次评估后12个月内的死亡率。
10名主治外科医生和18名外科住院医生对119名患者的“意外问题”给出了163份回答：60%的回答是“不，我不会感到意外”，40%的回答是“是，我会感到意外”。在二元逻辑回归中，“否”的回答与12个月内死亡几率增加相关（比值比4.8 [95%置信区间2.1 - 11.1]）。
“意外问题”是识别死亡风险较高老年患者的有价值工具，对于可能从姑息治疗评估中获益的老年急诊普通外科患者而言，它可能是一个有用的筛查标准。
