Accuracy of the "Surprise Question" in Predicting Long-Term Mortality Among Older Patients Admitted to the Emergency Department: Comparison Between Emergency Physicians and Nurses in a Multicenter Longitudinal Study.

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES
Palliative medicine reports Pub Date : 2024-08-26 eCollection Date: 2024-01-01 DOI:10.1089/pmr.2024.0010
Alexandra Coulon, Delphine Bourmorck, Françoise Steenebruggen, Laurent Knoops, Isabelle De Brauwer
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引用次数: 0

Abstract

Background: The "surprise question" (SQ) ("Would you be surprised if this patient died in the next 12 months?") is the most frequently used screening tool in emergency departments (EDs) to identify patients with poor prognosis and potential unmet palliative needs.

Objective: To test and compare the accuracy of the SQ between emergency nurses (ENs) and emergency physicians (EPs) in predicting long-term mortality among older patients (OP) in the ED.

Design and setting/subjects: A prospective cohort study of OPs (≥75 years) conducted in two Belgian EDs. EPs and ENs answered the SQ for the patients they cared for. Positive SQ (SQ+) was defined as a "no" answer. One-year mortality was assessed by phone call.

Results: EPs and ENs both answered the SQ for 291 OPs (mean age 83.2 ± 5.4, males 42.6%). The SQ was positive in 43% and 40.6%, respectively. Predictive values were similar in both groups: sensitivity, specificity, c-statistics, negative predictive value, and positive predictive value were 0.79 (0.66-0.88), 0.68 (0.62-0.76), 0.69 (0.63-0.75), 0.92 (0.86-0.96), and 0.4 (0.31-0.50), respectively, for EPs and 0.71 (0.57-0.82), 0.69 (0.62-0.75), 0.69 (0.63-0.75), 0.89 (0.83-0.93), and 0.41 (0.31-0.51), respectively, for ENs. SQ + was associated with a higher mortality risk in both group (EPs hazard ratio: 3.2 [1.6-6.7], p = 0.002; ENs hazard ratio: 2.5 [1.3-4.8], p = 0.006). The survival probability was lower when both EPs and ENs agreed on the SQ+ (p < 0.001).

Conclusion: The SQ is a simple tool to identify older ED patients at high mortality risk. Concordant responses from EPs and ENs are more predictive than either alone.

惊喜问题 "在预测急诊科收治的老年患者长期死亡率方面的准确性:一项多中心纵向研究中急诊医生与护士的比较。
背景:惊喜问题"(SQ)("如果这名患者在未来 12 个月内死亡,您会感到惊讶吗?")是急诊科(ED)最常用的筛查工具,用于识别预后不良和潜在姑息治疗需求未得到满足的患者:测试并比较急诊护士(ENS)和急诊医生(EP)在预测急诊室老年患者(OP)长期死亡率方面的准确性:在比利时两家急诊室对 OP(≥75 岁)进行前瞻性队列研究。EP 和 EN 对其护理的患者进行了 SQ 回答。SQ阳性(SQ+)定义为 "否 "答案。通过电话评估一年的死亡率:急诊科医生和门诊医生均回答了 291 名 OP(平均年龄为 83.2 ± 5.4 岁,男性占 42.6%)的 SQ。SQ阳性率分别为43%和40.6%。两组的预测值相似:灵敏度、特异性、c 统计量、阴性预测值和阳性预测值分别为 0.79(0.66-0.88)、0.68(0.62-0.76)、0.69(0.63-0.75)、0.92(0.86-0.96)和0.4(0.31-0.50);EP和EN分别为0.71(0.57-0.82)、0.69(0.62-0.75)、0.69(0.63-0.75)、0.89(0.83-0.93)和0.41(0.31-0.51)。SQ + 与两组患者较高的死亡风险相关(EPs 危险比:3.2 [1.6-6.7],p = 0.002;ENs 危险比:2.5 [1.3-4.8],p = 0.006)。当 EP 和 EN 就 SQ+ 达成一致时,生存概率较低(p < 0.001):结论:SQ 是识别高死亡风险老年急诊患者的简单工具。急诊科医生和急诊室医生的一致反应比单独任何一方的反应都更具预测性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
1.20
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