Coulon Alexandra, Bourmorck Delphine, Steenebruggen Françoise, Knoops Laurent, De Brauwer Isabelle
Palliative Care Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium.
Institute of Health and Society, UCLouvain, Brussels, Belgium.
Palliat Med Rep. 2024 Aug 26;5(1):387-395. doi: 10.1089/pmr.2024.0010. eCollection 2024.
The "surprise question" (SQ) ("Would you be surprised if this patient died in the next 12 months?") is the most frequently used screening tool in emergency departments (EDs) to identify patients with poor prognosis and potential unmet palliative needs.
To test and compare the accuracy of the SQ between emergency nurses (ENs) and emergency physicians (EPs) in predicting long-term mortality among older patients (OP) in the ED.
DESIGN AND SETTING/SUBJECTS: A prospective cohort study of OPs (≥75 years) conducted in two Belgian EDs. EPs and ENs answered the SQ for the patients they cared for. Positive SQ (SQ+) was defined as a "no" answer. One-year mortality was assessed by phone call.
EPs and ENs both answered the SQ for 291 OPs (mean age 83.2 ± 5.4, males 42.6%). The SQ was positive in 43% and 40.6%, respectively. Predictive values were similar in both groups: sensitivity, specificity, c-statistics, negative predictive value, and positive predictive value were 0.79 (0.66-0.88), 0.68 (0.62-0.76), 0.69 (0.63-0.75), 0.92 (0.86-0.96), and 0.4 (0.31-0.50), respectively, for EPs and 0.71 (0.57-0.82), 0.69 (0.62-0.75), 0.69 (0.63-0.75), 0.89 (0.83-0.93), and 0.41 (0.31-0.51), respectively, for ENs. SQ + was associated with a higher mortality risk in both group (EPs hazard ratio: 3.2 [1.6-6.7], = 0.002; ENs hazard ratio: 2.5 [1.3-4.8], = 0.006). The survival probability was lower when both EPs and ENs agreed on the SQ+ ( < 0.001).
The SQ is a simple tool to identify older ED patients at high mortality risk. Concordant responses from EPs and ENs are more predictive than either alone.
“意外问题”（SQ）（“如果该患者在接下来的12个月内死亡，您会感到意外吗？”）是急诊科（ED）中最常用的筛查工具，用于识别预后不良和可能未满足的姑息治疗需求的患者。
测试并比较急诊护士（ENs）和急诊医生（EPs）在预测急诊科老年患者（OP）长期死亡率方面SQ的准确性。
设计与设置/研究对象：在比利时的两家急诊科对老年患者（≥75岁）进行的一项前瞻性队列研究。EPs和ENs对他们护理的患者回答了SQ。阳性SQ（SQ+）定义为“否”的回答。通过电话评估一年死亡率。
EPs和ENs均对291名老年患者回答了SQ（平均年龄83.2±5.4岁，男性占42.6%）。SQ阳性率分别为43%和40.6%。两组的预测值相似：EPs的敏感性、特异性、c统计量、阴性预测值和阳性预测值分别为0.79（0.66 - 0.88）、0.68（0.62 - 0.76）、0.69（0.63 - 0.75）、0.92（0.86 - 0.96）和0.4（0.31 - 0.50），ENs的分别为0.71（0.57 - 0.82）、0.69（0.62 - 0.75）、0.69（0.63 - 0.75）、0.89（0.83 - 0.93）和0.41（0.31 - 0.51）。两组中SQ+均与较高的死亡风险相关（EPs风险比：3.2[1.6 - 6.7]，P = 0.002；ENs风险比：2.5[1.3 - 4.8]，P = 0.006）。当EPs和ENs对SQ+的回答一致时，生存概率较低（P < 0.001）。
SQ是一种识别急诊科高死亡风险老年患者的简单工具。EPs和ENs一致的回答比单独的回答更具预测性。
