The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis

作者：Ankit Gupta, Ruth Burgess, Michael Drozd, John Gierula, Klaus K. Witte, Sam Straw · 发表于：BMJ Supportive & Palliative Care · 年份：2024 · DOI：10.1136/spcare-2024-004879 · 被引用次数：32 · 研究领域：Palliative Care and End-of-Life Issues、Frailty in Older Adults、Health Systems, Economic Evaluations, Quality of Life

Background The Surprise Question, ‘Would you be surprised if this person died within the next year?’ is a simple tool that can be used by clinicians to identify people within the last year of life. This review aimed to determine the accuracy of this assessment, across different healthcare settings, specialties, follow-up periods and respondents. Methods Searches were conducted of Medline, Embase, AMED, PubMed and the Cochrane Central Register of Controlled Trials, from inception until 01 January 2024. Studies were included if they reported original data on the ability of the Surprise Question to predict survival. For each study (including subgroups), sensitivity, specificity, positive and negative predictive values and accuracy were determined. Results Our dataset comprised 56 distinct cohorts, including 68 829 patients. In a pooled analysis, the sensitivity of the Surprise Question was 0.69 ((0.64 to 0.74) I 2 =97.2%), specificity 0.69 ((0.63 to 0.74) I 2 =99.7%), positive predictive value 0.40 ((0.35 to 0.45) I 2 =99.4%), negative predictive value 0.89 ((0.87 to 0.91) I 2 =99.7%) and accuracy 0.71 ((0.68 to 0.75) I 2 =99.3%). The prompt performed best in populations with high event rates, shorter timeframes and when posed to more experienced respondents. Conclusions The Surprise Question demonstrated modest accuracy with considerable heterogeneity across the population to which it was applied and to whom it was posed. Prospective studies should test whether the prompt can f...