Prognostic value of the Surprise Question for one-year mortality in older patients: a prospective multicenter study in acute geriatric and cardiology units. | LitMetric
Objectives: To determine the prognostic value of the Surprise Question (SQ) in older persons.
Methods: A multicenter prospective study, including patients aged 75 years or older admitted to acute geriatric (AGU) or cardiology unit (CU). The SQ was answered by the treating physician. Patients or relatives were contacted after 1 year to determine 1-year survival. Logistic regression was used to explore parameters associated with SQ. Summary ROC curves were constructed to obtain the pooled values of sensitivity and specificity based on a bivariate model.
Results: The SQ was positive (death within 1 year is no surprise) in 34.7% AGU and 33.3% CU patients (p = 0.773). Parameters associated with a positive SQ were more severe comorbidity, worse functionality, significant weight loss, refractory symptoms and the request for palliative care by patient or family. One-year mortality was, respectively, 24.9% and 20.2% for patients hospitalized on AGU and CU (p = 0.319). There was no difference in sensitivity or specificity, respectively, 64% and 77% (AUC 0.635) for AGU versus 63% and 76% (AUC 0.758) for CU (p = 0.870). A positive SQ is associated with a significant shorter time until death (HR 5.425 (95% CI 3.332-8.834), p < 0.001) independently from the ward.
Conclusion: The Surprise Question is moderately accurate to predict 1-year mortality in older persons hospitalized on acute geriatric and cardiologic units.
» Advance care planning and palliative care can improve care for orthopedic patients.» The "surprise question" is a useful prognostication tool and trigger for palliative care referral.» Engage in routine advance care planning conversations.
Purpose: Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians' prognostic confidence.
Methods: In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w, and 3 d.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 22, 52074 Aachen, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR University Hospital Essen, Wickenburgstr, 21, 45147 Essen, Germany. Electronic address:
Objective: Although proven neuronal changes are correlated with anorexia nervosa (AN), where these changes occur and how they change during the course of this disease are often unclear; this is especially true regarding emotion processing, e.g., of anxiety, despite a growing body of literature on its importance for the pathophysiology and clinical course of patients with AN.
The study investigated how to identify hospitalized patients who might benefit from serious illness conversations (SICs) by combining Epic's Risk of Readmission Score (RRS) with a simple question about expected mortality ("Would you be surprised if the patient died in the next 12 months?").
Researchers analyzed patient encounters from January 2019 to October 2021, finding that 77.2% of patients with a high RRS were considered unlikely to survive the next year, and these patients had higher rates of documented SICs.
Despite a significant portion of these patients needing SICs, the overall rates of having these conversations were very low, suggesting that using both EHR data and
Background: Adults with frailty have palliative care needs [1] but have disproportionately less access to palliative care services [2]. Frailty affects ~4000 patients admitted to hospital per day in the UK [3], making the hospital admission a unique opportunity to assess palliative care needs and deliver interventions.
Objectives: Synthesise the evidence regarding hospital palliative care (HPC) for patients with frailty.
