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Citation
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Hoffman MR, Slivinski A, Shen Y, Watts DD, Wyse RJ, Garland JM, Fakhry SM. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: The Surprise Question (SQ) ("Would I be surprised if the patient died within the next year?") is a validated tool used to identify patients with limited life expectancy. As it may have potential to expedite palliative care interventions per ACS TQIP Palliative Care Best Practices Guidelines, we sought to determine if trauma team members could utilize the SQ to accurately predict 1-year mortality in trauma patients.
METHODS: A multicenter, prospective, cohort study collected data (8/20-2/21) on trauma team members' responses to the SQ at 24 hours from admission. One-year mortality was obtained via social security death index records. Positive/negative predictive values (PPV/NPV) and accuracy were calculated overall, by provider role, and by patient age.
RESULTS: Ten Level I/II centers enrolled 1172 patients (87.9% blunt). Median age was 57 (IQR 36-74), median ISS 10 (IQR 5-14). Overall 1-year mortality was 13.3%. Positive predictive value (PPV), was low (30.5%) regardless of role. Mortality prediction minimally improved as age increased (PPV highest between 65-74 years old, 34.5%), but consistently trended to over-prediction of death, even in younger patients.
CONCLUSIONS: Trauma team members' ability to forecast 1-year mortality using the SQ at 24 hours appears limited perhaps due to overestimation of injury effects, pre-injury conditions and/or team bias. This has implications for the TQIP Guidelines and suggests that more research is needed to determine the optimal time to screen trauma patients with the SQ. LEVEL OF EVIDENCE: Level III, Prognostic/Epidemiological.
Language: en |