Utility of the ''Surprise'' Question in Predicting Survival among Older Patients with Acute Surgical Conditions
Utility of the ''Surprise'' Question in Predicting Survival among Older Patients with Acute Surgical Conditions
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DOI：
10.1089/jpm.2016.0313
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发表时间：
2017-04-01
影响因子：
2.8
通讯作者：
Cooper, Zara
中科院分区：
文献类型：
--
作者：
Lilley, Elizabeth J.;Gemunden, Sean A.;Cooper, Zara
背景：意外问题是一种经过验证的工具，用于识别一年内死亡风险增加的患者，这些患者因此可能从姑息治疗中获益。然而，其在外科手术中的应用情况尚不明确。
目的：我们试图确定意外问题是否能预测老年急诊普通外科患者12个月内的死亡率。
设计：这是一项前瞻性队列研究。
地点/研究对象：2014年1月至7月在一家三级医疗学术医院接受培训三年及以上的急诊普通外科主治医师和外科住院医师。
测量：外科医生在对65岁及以上因急性外科疾病住院的患者进行评估后的72小时内回答意外问题。从病历中提取患者数据，包括人口统计学和临床特征。通过社会保障死亡数据确定初次评估后12个月内的死亡率。
结果：10名主治医师和18名外科住院医师对119名患者的意外问题提供了163次回答：60%的回答是“不，我不会感到意外”，40%的回答是“是，我会感到意外”。在二元逻辑回归中，“不”的回答与12个月内死亡几率增加相关（比值比4.8[95%置信区间2.1 - 11.1]）。
结论：意外问题是识别死亡风险较高的老年患者的有价值工具，并且它可能是对能从姑息治疗评估中获益的老年急诊普通外科患者的一个有用筛选标准。
Background: The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown.Objective: We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients.Design: This was a prospective cohort study.Setting/Subjects: Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014.Measurements: Surgeons responded to the surprise question within 72 hours of evaluating patients, >= 65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data.Results: Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were ''No, I would not be surprised'' and 40% were ''Yes, I would be surprised.'' A ''No'' response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]).Conclusions: The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.