Yen Yung-Feng, Huang Shu-Fen, Chen Shu-Ting, Deng Chung-Yeh
Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan.
Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Clin Nurs. 2024 Mar 8. doi: 10.1111/jocn.17096.
To assess the prognostic accuracy of the surprise question (SQ) when used by nurses working in hospital wards to determine 1-year mortality in acutely hospitalised older patients.
The predictive accuracy of the SQ, when used by general nurses caring for older hospitalised patients, has not been comprehensively studied.
A prospective cohort study.
This cohort study recruited consecutive 10,139 older patients (aged ≥65 years) who were admitted to Taipei City Hospital and were evaluated for the needs of palliative care in 2015. All patients were followed up for 12 months or until their death. The c-statistic value was calculated to indicate the predictive accuracy of the SQ and Palliative Care Screening Tool (PCST).
Of all participants, 18.8% and 18.6% had a SQ response of 'no' and a PCST score ≥4, respectively. After controlling for other covariates, an SQ response of 'no' (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.83-2.31) and a PCST score ≥4 (AHR = 1.50; 95% CI: 1.29-1.75) were found to be the independent predictors for patients' 12-month mortality. The C-statistic values of the SQ and the PCST at recognising patients in their last year of life were .663 and .670, respectively. Moreover, there was moderate concordance (k = .44) between the SQ and the PCST in predicting 12-month mortality.
SQ response of 'no' and a PCST score ≥4 were independent predictors of 12-month mortality in older patients.
The SQ, when used by nurses working in hospital wards, is effective in identifying older patients nearing the end of life, as well as in providing advance care planning for patients.
Patients' palliative care needs at admission were assessed by general nurses using the SQ and PCST.
评估医院病房护士使用意外问题（SQ）来确定急性住院老年患者1年死亡率时的预后准确性。
普通护士在护理住院老年患者时使用SQ的预测准确性尚未得到全面研究。
一项前瞻性队列研究。
该队列研究纳入了2015年连续收治于台北市立医院且接受姑息治疗需求评估的10139名老年患者（年龄≥65岁）。所有患者均随访12个月或直至死亡。计算c统计值以表明SQ和姑息治疗筛查工具（PCST）的预测准确性。
在所有参与者中，分别有18.8%和18.6%的患者SQ回答为“否”且PCST评分≥4。在控制其他协变量后，发现SQ回答为“否”（调整后风险比[aHR]，2.05；95%置信区间[CI]，1.83 - 2.31）和PCST评分≥4（AHR = 1.50；95% CI：1.29 - 1.75）是患者12个月死亡率的独立预测因素。SQ和PCST识别生命最后一年患者的c统计值分别为0.663和0.670。此外，SQ和PCST在预测12个月死亡率方面存在中度一致性（k = 0.44）。
SQ回答为“否”和PCST评分≥4是老年患者12个月死亡率的独立预测因素。
医院病房护士使用的SQ在识别接近生命末期的老年患者以及为患者提供预先护理计划方面是有效的。
普通护士使用SQ和PCST评估患者入院时的姑息治疗需求。
