The "Surprise Question" for Prognostication in People With Parkinson's Disease and Related Disorders.
The "Surprise Question" for Prognostication in People With Parkinson's Disease and Related Disorders.
复制标题
帕金森病及相关疾病患者的预测“令人惊讶的问题”。
DOI：
10.1016/j.jpainsymman.2023.10.004
复制
发表时间：
2024
影响因子：
4.7
通讯作者：
Kluger,BenziM
中科院分区：
文献类型：
--
作者：
Mahes,Ananth;Macchi,ZacharyA;Martin,ChristineS;Katz,Maya;Galifianakis,NicholasB;Pantilat,StevenZ;Kutner,JeanS;Sillau,Stefan;Kluger,BenziM
帕金森病及相关疾病（PDRD）是一种致命的神经退行性疾病，其特征是波动性病程，可使预后复杂化。“惊喜问题”（SQ：“如果你的病人在明年去世，你会感到惊讶吗？”）已被用来确定患者的预后有限，但尚未进行评估，在PDRD.ObjectivesTo确定SQ在预测12个月的死亡率在PDRD.MethodsData的有效性进行了分析，从301例患者和34个社区为基础的神经科医生谁参加了一项临床试验的门诊姑息治疗PDRD患者。临床医生在基线时回答了每例患者的SQ。使用基线时的描述性统计、独立性卡方检验、2 × 2和2 × 3交叉表。生存分析使用Kaplan-Meier曲线比较SQ应答。风险估计分析确定了与临床医生的responses.ResultsMortality患者的特点是10.3%（N= 31）在1年。SQ的敏感性和特异性分别为80.7%和58.9%，AUC = 0.70，阳性预测值为18.4%，阴性预测值为96.4%。年龄较大，非典型帕金森综合征，痴呆症与响应“不”SQ.ConclusionThe SQ是敏感的PDRD 12个月的死亡率，具有较高的阴性预测值。SQ可能有助于识别不太可能在一年内死亡的患者，并且可能有助于识别在临终关怀之外需要姑息治疗的患者。后者的使用可能有助于动员早期和及时转诊到专科姑息治疗。
ContextParkinson's disease and related disorders (PDRD) are fatal neurodegenerative disorders characterized by a fluctuating course that can complicate prognostication. The “surprise question” (SQ: “Would you be surprised if your patient died in the next year?”) has been used to identify patients with limited prognosis but has not been assessed in PDRD.ObjectivesTo determine the validity of the SQ in predicting 12-month mortality in PDRD.MethodsData was analyzed from 301 patients and 34 community-based neurologists who were participating in a clinical trial of outpatient palliative care for patients with PDRD. Clinicians answered the SQ for each patient at baseline. Descriptive statistics at baseline, chi-square tests of independence, 2 × 2 and 2 × 3 cross tables were used. Survival analysis compared SQ responses using Kaplan-Meier curves. Risk estimate analyses identified patient characteristics associated with clinicians’ responses.ResultsMortality was 10.3% (N= 31) at 1 year. The sensitivity and specificity of the SQ was 80.7% and 58.9%, respectively with AUC = 0.70, positive predictive value of 18.4% and negative predictive value of 96.4%. Older age, atypical parkinsonism, and dementia were associated with responding “no” to the SQ.ConclusionThe SQ is sensitive to 12-month mortality in PDRD, with a high negative predictive value. The SQ may be useful for identifying patients less likely to die within a year and may be useful for identifying patients with palliative care needs outside of end-of-life care. This latter use may assist in mobilizing early and timely referral to specialist palliative care.
遗传学和衰老
DOI：
--
发表时间：
1978
期刊：
影响因子：
--
作者：
F. Lints
通讯作者：
F. Lints