Weill Institute for Neurosciences (A.M., N.B.G.), University of California San Francisco, San Francisco, California.
Department of Neurology (Z.A.M., C.S.M., S.S.), University of Colorado School of Medicine, Aurora, Colorado.
J Pain Symptom Manage. 2024 Jan;67(1):e1-e7. doi: 10.1016/j.jpainsymman.2023.10.004. Epub 2023 Oct 13.
Parkinson's disease and related disorders (PDRD) are fatal neurodegenerative disorders characterized by a fluctuating course that can complicate prognostication. The "surprise question" (SQ: "Would you be surprised if your patient died in the next year?") has been used to identify patients with limited prognosis but has not been assessed in PDRD.
To determine the validity of the SQ in predicting 12-month mortality in PDRD.
Data was analyzed from 301 patients and 34 community-based neurologists who were participating in a clinical trial of outpatient palliative care for patients with PDRD. Clinicians answered the SQ for each patient at baseline. Descriptive statistics at baseline, chi-square tests of independence, 2 × 2 and 2 × 3 cross tables were used. Survival analysis compared SQ responses using Kaplan-Meier curves. Risk estimate analyses identified patient characteristics associated with clinicians' responses.
Mortality was 10.3% (N = 31) at 1 year. The sensitivity and specificity of the SQ was 80.7% and 58.9%, respectively with AUC = 0.70, positive predictive value of 18.4% and negative predictive value of 96.4%. Older age, atypical parkinsonism, and dementia were associated with responding "no" to the SQ.
The SQ is sensitive to 12-month mortality in PDRD, with a high negative predictive value. The SQ may be useful for identifying patients less likely to die within a year and may be useful for identifying patients with palliative care needs outside of end-of-life care. This latter use may assist in mobilizing early and timely referral to specialist palliative care.
帕金森病及相关障碍（PDRD）是致命的神经退行性疾病，其病程波动，预测预后较为复杂。“意外问题”（SQ：“如果您的患者在明年内去世，您会感到意外吗？”）已被用于识别预后有限的患者，但尚未在 PDRD 中进行评估。
确定 SQ 预测 PDRD 患者 12 个月死亡率的有效性。
对 301 名患者和 34 名参与 PDRD 门诊姑息治疗临床试验的社区神经科医生进行了数据分析。临床医生在基线时为每位患者回答 SQ。使用基线描述性统计、独立性卡方检验、2×2 和 2×3 交叉表进行分析。生存分析比较了 Kaplan-Meier 曲线的 SQ 反应。风险估计分析确定了与临床医生反应相关的患者特征。
1 年后死亡率为 10.3%（N=31）。SQ 的灵敏度和特异性分别为 80.7%和 58.9%，AUC 为 0.70，阳性预测值为 18.4%，阴性预测值为 96.4%。年龄较大、非典型帕金森病和痴呆与对 SQ 回答“否”相关。
SQ 对 PDRD 12 个月死亡率敏感，阴性预测值高。SQ 可能有助于识别不太可能在一年内死亡的患者，也可能有助于识别需要姑息治疗的患者，而不仅仅是在生命末期护理。后者的使用可能有助于早期和及时转介到专业姑息治疗。
