Theunissen Maurice, Lardenoye Sacha, van den Beuken-van Everdingen Marieke H J, Stassen Patricia M
Center of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Emergency Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Ann Med. 2025 Dec;57(1):2529575. doi: 10.1080/07853890.2025.2529575. Epub 2025 Jul 16.
The 'surprise question' (SQ) asks care professionals to assess the patient's mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ/SQ) answered by nurses and physicians in unselected adult emergency department (ED) patients, and in high risk subgroups (age ≥ 50 y; medical patients), 2) the agreement between these care professionals.
In this prospective study, the SQ and SQ were scored by nurses and physicians. AU-ROC, sensitivity, specificity, and negative predictive value (NPV) were calculated.Kappa values and absolute agreement were calculated.
In total, 1958 patients were assessed. Mortality within 12 months was 13.9% in all patients (8.3% within 3 months), 22.9% in older and 20.1% in medical patients. The AU-ROC of the SQ was 0.639 and 0.698 for nurses and physicians, resp., and that of the SQ was 0.722 and 0.847, resp. For SQ, sensitivity was 46.8-48.0%, and specificity 93.9-95.1%, with high NPV (95.6-97.0%). For SQ, sensitivity was higher (54.1-60.8%), with specificity of 83.4-96.4%, and high NPV. AU-ROCs for the two high risk subgroups were comparable. Agreement was fair (kappa 0.255) for SQ, and moderate (kappa 0.461) for SQ, while absolute agreement was 91.4% and 80.5%, resp.
The study supports the SQ as a simple prognostic tool in the ED, with 12-month prognostic accuracy being especially reliable in high-risk patients. The agreement between nurses and physicians was fair-moderate. The SQ could play an important role in guiding ED care, especially in high-risk patients.
“意外问题”（SQ）要求医护人员评估患者的死亡风险。在这项前瞻性研究中，我们调查了：1）护士和医生对未筛选的成年急诊科（ED）患者以及高危亚组（年龄≥50岁；内科患者）回答的关于3个月和12个月死亡率（SQ/SQ）的SQ的预后准确性；2）这些医护人员之间的一致性。
在这项前瞻性研究中，护士和医生对SQ和SQ进行评分。计算了AU-ROC、敏感性、特异性和阴性预测值（NPV）。计算了Kappa值和绝对一致性。
总共评估了1958例患者。所有患者12个月内的死亡率为13.9%（3个月内为8.3%），老年患者为22.9%，内科患者为20.1%。护士和医生的SQ的AU-ROC分别为0.639和0.698，SQ的AU-ROC分别为0.722和0.847。对于SQ，敏感性为46.8-48.0%，特异性为93.9-95.1%，NPV较高（95.6-97.0%）。对于SQ，敏感性较高（54.1-60.8%），特异性为83.4-96.4%，NPV较高。两个高危亚组的AU-ROC具有可比性。SQ方面的一致性为中等（kappa 0.255），SQ方面的一致性为中等（kappa 0.461），而绝对一致性分别为91.4%和80.5%。
该研究支持将SQ作为急诊科的一种简单预后工具，12个月的预后准确性在高危患者中尤其可靠。护士和医生之间的一致性为中等。SQ在指导急诊科护理方面可能发挥重要作用，尤其是在高危患者中。
