Evaluating Performance of the Surprise Question to Predict 12-Month Mortality in Patients With End-Stage Liver Disease.
Sarah Homann, Jamie Pfaff, Elizabeth Stovicek and 8 others
PMID 39952927WHAT IT FOUND
In hospitalized end-stage liver disease patients, a hepatologist's 'not surprised' answer was linked with 58.4% survival at a year versus 92.3% for 'surprised', but 160 of 274 flagged patients did not die.
Key findings
01Patients whose hepatologist answered 'not surprised' had lower survival at 365 days than those whose hepatologist answered 'surprised' (58.4% vs 92.3%; P < 0.001).
02Of 274 patients the surprise question predicted to die, 114 died within 1 year and 160 did not; of 104 predicted to survive, 8 died.
03The surprise question had 93.4% sensitivity, 37.5% specificity, 41% positive predictive value, and 92% negative predictive value for 1-year mortality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one academic quaternary hospital and only in inpatients, so it may not apply to outpatients or other settings. The surprise question was answered only by physicians, not by nurses or advanced practice providers, so the results may not reflect nursing judgment. The sample was predominantly white, non-Hispanic, and male, so it may not represent all people with end-stage liver disease. The parent study ran in 2017 to 2018, when MELD scores did not include dialysis status, so current MELD comparisons may differ. It was retrospective, and some patients had the question repeated after readmission, which was described qualitatively rather than as a controlled test.
Declared interests
The authors declared no potential conflicts of interest. The project was supported in part by the Vanderbilt Institute for Clinical and Translational Research under a CTSA award from the National Center for Advancing Translational Sciences.
The easy way to misread this
Do not treat a 'not surprised' answer as proof a patient will die within a year. Most flagged patients did not die: 160 of 274 flagged patients did not die within a year.