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The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis

Canadian Medical Association journal (CMAJ), 2017-04, Vol.189 (13), p.E484-E493 [Peer Reviewed Journal]

2017 Canadian Medical Association or its licensors. ;COPYRIGHT 2017 Joule Inc. ;Copyright 8872147 Canada Inc. Apr 3, 2017 ;2017 Joule Inc. or its licensors 2017 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.160775 ;PMID: 28385893 ;CODEN: CMAJAX

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  • Title:
    The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis
  • Author: Downar, James ; Goldman, Russell ; Pinto, Ruxandra ; Englesakis, Marina ; Adhikari, Neill K J
  • Subjects: Care and treatment ; Critically ill ; Critically ill persons ; Death ; Health aspects ; Hospice care ; Humans ; Medical research ; Medicine, Experimental ; Meta-analysis ; Models, Theoretical ; Neoplasms - mortality ; Palliative Care ; Palliative treatment ; Patients ; Predictive Value of Tests ; Prognosis ; Quality of care ; Randomized Controlled Trials as Topic ; ROC Curve ; Studies ; Systematic review
  • Is Part Of: Canadian Medical Association journal (CMAJ), 2017-04, Vol.189 (13), p.E484-E493
  • Description: The surprise question - "Would I be surprised if this patient died in the next 12 months?" - has been used to identify patients at high risk of death who might benefit from palliative care services. Our objective was to systematically review the performance characteristics of the surprise question in predicting death. We searched multiple electronic databases from inception to 2016 to identify studies that prospectively screened patients with the surprise question and reported on death at 6 to 18 months. We constructed models of hierarchical summary receiver operating characteristics (sROCs) to determine prognostic performance. Sixteen studies (17 cohorts, 11 621 patients) met the selection criteria. For the outcome of death at 6 to 18 months, the pooled prognostic characteristics were sensitivity 67.0% (95% confidence interval [CI] 55.7%-76.7%), specificity 80.2% (73.3%-85.6%), positive likelihood ratio 3.4 (95% CI 2.8-4.1), negative likelihood ratio 0.41 (95% CI 0.32-0.54), positive predictive value 37.1% (95% CI 30.2%-44.6%) and negative predictive value 93.1% (95% CI 91.0%-94.8%). The surprise question had worse discrimination in patients with noncancer illness (area under sROC curve 0.77 [95% CI 0.73-0.81]) than in patients with cancer (area under sROC curve 0.83 [95% CI 0.79-0.87; = 0.02 for difference]). Most studies had a moderate to high risk of bias, often because they had a low or unknown participation rate or had missing data. The surprise question performs poorly to modestly as a predictive tool for death, with worse performance in noncancer illness. Further studies are needed to develop accurate tools to identify patients with palliative care needs and to assess the surprise question for this purpose.
  • Publisher: Canada: Joule Inc
  • Language: English
  • Identifier: ISSN: 0820-3946
    EISSN: 1488-2329
    DOI: 10.1503/cmaj.160775
    PMID: 28385893
    CODEN: CMAJAX
  • Source: ProQuest One Psychology
    GFMER Free Medical Journals
    MEDLINE
    PubMed Central
    Alma/SFX Local Collection
    ProQuest Central
    DOAJ Directory of Open Access Journals
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