Silva Alini Maria Orathes Ponte, Miranda Diego Lopes Paim, Ferreira David Pereira, Campos Camilla Correia de Araujo Pereira, Crusoé Edvan de Queiroz, Gomes Felipe Feistauer, Favano Thiago, Salvino Marco Aurélio
Postgraduate Program in Medicine and Heath, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
Sao Paulo Med J. 2025 May 2;143(3):e2024263. doi: 10.1590/1516-3180.2024.0263.29012025. eCollection 2025.
The Surprise Question (SQ), "Would I be surprised if this patient were to die in the next 12 months?", identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology.
To evaluate the performance of the SQ among inpatients with hematologic malignancies.
A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil.
Physicians answered the SQ (not surprised (SQ+) or surprised (SQ-)). Mortality data were assessed after one year.
Eighty-one patients were included (56% SQ+ and 44% SQ-). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7-11.8) for SQ- and 5.6 months (95%CI = 4.1-7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study's end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001).
Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.
“意外问题”（SQ），即“如果该患者在未来12个月内死亡，我会感到意外吗？”，可识别出可能从姑息治疗（PC）中获益的高死亡风险患者。然而，关于其在血液肿瘤学中的应用知之甚少。
评估“意外问题”在血液系统恶性肿瘤住院患者中的表现。
2021年9月至12月进行了一项前瞻性队列研究，纳入巴西萨尔瓦多大学医院血液科病房的患者。
医生回答“意外问题”（不意外（SQ+）或意外（SQ-））。一年后评估死亡率数据。
纳入81例患者（56%为SQ+，44%为SQ-）。研究结束时，36例患者（44%）死亡。SQ-组的中位生存期为10.8个月（95%CI = 9.7 - 11.8），SQ+组为5.6个月（95%CI = 4.1 - 7.1）。敏感性为86.1%，特异性为68.9%，阳性预测值为68.8%，阴性预测值为86.1%，准确性为76.5%。在访谈时，只有15例（18.5%）患者咨询过姑息治疗专科医生。到研究结束时，48%的患者已被转诊至姑息治疗。这些患者的功能状态较差（82%对40%，P < 0.001），且有更多的预先护理计划记录（87%对14%，P < 0.001）。
尽管血液系统恶性肿瘤的预后存在不确定性，但“意外问题”能有效估计死亡率，是血液肿瘤学中早期整合姑息治疗的有价值工具。
