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The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians: predictive accuracy in an unselected emergency department population - a prospective study in nurses and physicians

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Název: The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians: predictive accuracy in an unselected emergency department population - a prospective study in nurses and physicians
Autoři: Maurice Theunissen, Sacha Lardenoye, Marieke H. J. van den Beuken-van Everdingen, Patricia M. Stassen
Zdroj: Ann Med
Annals of Medicine, Vol 57, Iss 1 (2025)
Informace o vydavateli: Informa UK Limited, 2025.
Rok vydání: 2025
Témata: Surprise question, predictive accuracy, emergency department, Emergency Medicine, Medicine, NEEDS
Popis: The ‘surprise question’ (SQ) asks care professionals to assess the patient’s mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ3/SQ12) answered by nurses and physicians in unselected adult emergency department (ED) patients, and in high risk subgroups (age ≥ 50 y; medical patients), 2) the agreement between these care professionals. In this prospective study, the SQ3 and SQ12 were scored by nurses and physicians. AU-ROC, sensitivity, specificity, and negative predictive value (NPV) were calculated.Kappa values and absolute agreement were calculated. In total, 1958 patients were assessed. Mortality within 12 months was 13.9% in all patients (8.3% within 3 months), 22.9% in older and 20.1% in medical patients. The AU-ROC of the SQ3 was 0.639 and 0.698 for nurses and physicians, resp., and that of the SQ12 was 0.722 and 0.847, resp. For SQ3, sensitivity was 46.8–48.0%, and specificity 93.9–95.1%, with high NPV (95.6–97.0%). For SQ12, sensitivity was higher (54.1–60.8%), with specificity of 83.4–96.4%, and high NPV. AU-ROCs for the two high risk subgroups were comparable. Agreement was fair (kappa 0.255) for SQ3, and moderate (kappa 0.461) for SQ12, while absolute agreement was 91.4% and 80.5%, resp. The study supports the SQ as a simple prognostic tool in the ED, with 12-month prognostic accuracy being especially reliable in high-risk patients. The agreement between nurses and physicians was fair-moderate. The SQ could play an important role in guiding ED care, especially in high-risk patients.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1365-2060
0785-3890
DOI: 10.1080/07853890.2025.2529575
DOI: 10.6084/m9.figshare.29580855
DOI: 10.6084/m9.figshare.29580855.v1
Přístupová URL adresa: https://doaj.org/article/63fb599a9e5949028aa09bd5ba3cc172
Rights: CC BY NC
CC BY
URL: http://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (http://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
Přístupové číslo: edsair.doi.dedup.....59bcadb5a3f35407aead4ae6fef2111d
Databáze: OpenAIRE
Popis
Abstrakt:The ‘surprise question’ (SQ) asks care professionals to assess the patient’s mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ3/SQ12) answered by nurses and physicians in unselected adult emergency department (ED) patients, and in high risk subgroups (age ≥ 50 y; medical patients), 2) the agreement between these care professionals. In this prospective study, the SQ3 and SQ12 were scored by nurses and physicians. AU-ROC, sensitivity, specificity, and negative predictive value (NPV) were calculated.Kappa values and absolute agreement were calculated. In total, 1958 patients were assessed. Mortality within 12 months was 13.9% in all patients (8.3% within 3 months), 22.9% in older and 20.1% in medical patients. The AU-ROC of the SQ3 was 0.639 and 0.698 for nurses and physicians, resp., and that of the SQ12 was 0.722 and 0.847, resp. For SQ3, sensitivity was 46.8–48.0%, and specificity 93.9–95.1%, with high NPV (95.6–97.0%). For SQ12, sensitivity was higher (54.1–60.8%), with specificity of 83.4–96.4%, and high NPV. AU-ROCs for the two high risk subgroups were comparable. Agreement was fair (kappa 0.255) for SQ3, and moderate (kappa 0.461) for SQ12, while absolute agreement was 91.4% and 80.5%, resp. The study supports the SQ as a simple prognostic tool in the ED, with 12-month prognostic accuracy being especially reliable in high-risk patients. The agreement between nurses and physicians was fair-moderate. The SQ could play an important role in guiding ED care, especially in high-risk patients.
ISSN:13652060
07853890
DOI:10.1080/07853890.2025.2529575