1 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
2 Department of Emergency Medicine, Harvard Medical School , Boston, Massachusetts.
J Palliat Med. 2018 Feb;21(2):236-240. doi: 10.1089/jpm.2017.0192. Epub 2017 Aug 28.
Identification of older adults with serious illness (life expectancy less than one year) who may benefit from serious illness conversations or other palliative care interventions in the emergency department (ED) is difficult.
To assess the performance of the "surprise question (SQ)" asked of emergency physicians to predict 12-month mortality.
We asked attending emergency physician "Would you be surprised whether this patient died in the next 12 months?" regarding patients ≥65 years old that they had cared for that shift. We prospectively obtained death records from Massachusetts Department of Health Vital Records.
An urban, university-affiliated ED.
Twelve-month mortality.
We approached 38 physicians to answer the SQ, and 86% participated. The mean age of our cohort was 76 years, 51% were male, and 45% had at least one serious illness. Out of 207 patients, the physicians stated that they "would not be surprised" if the patient died in the next 12 months for 102 of the patients (49%); 44 of the 207 patients (21%) died within 12 months. The SQ demonstrated sensitivity of 77%, specificity of 56%, positive predictive value of 32%, and negative predictive value of 90%. When combined with other predictors, the model sorted the patient who lived from the patient who died correctly 72% of the time (c-statistic = 0.72).
Use of the SQ by emergency physicians may predict 12-month mortality in older ED patients and may help emergency physicians identify older adults in need of palliative care interventions.
识别患有严重疾病（预期寿命不到一年）的老年人，他们可能从急诊科（ED）的严重疾病对话或其他姑息治疗干预中受益，这是困难的。
评估向急诊医师提出的“意外问题（SQ）”预测 12 个月死亡率的性能。
我们询问主治急诊医师“您是否会对该患者在未来 12 个月内死亡感到惊讶？”关于他们在该班次照顾的年龄≥65 岁的患者。我们前瞻性地从马萨诸塞州卫生部的《生命记录》中获取死亡记录。
城市，大学附属医院 ED。
12 个月死亡率。
我们联系了 38 位医生来回答 SQ，有 86%的医生参与了调查。我们队列的平均年龄为 76 岁，51%为男性，45%至少有一种严重疾病。在 207 名患者中，医生表示，如果患者在接下来的 12 个月内死亡，他们“不会感到惊讶”，其中 102 名患者（49%）；207 名患者中有 44 名（21%）在 12 个月内死亡。SQ 的敏感性为 77%，特异性为 56%，阳性预测值为 32%，阴性预测值为 90%。当与其他预测因素结合使用时，该模型正确地将存活患者与死亡患者区分开的比例为 72%（c 统计量=0.72）。
急诊医师使用 SQ 可能预测老年 ED 患者的 12 个月死亡率，并有助于急诊医师识别需要姑息治疗干预的老年人。
