Utility of the "surprise" question to identify dialysis patients with high mortality.
OBJECTIVE
Dialysis patients are increasingly characterized by older age, multiple comorbidities, and shortened life expectancy. This study investigated whether the "surprise" question, "Would I be surprised if this patient died in the next year?" identifies patients who are at high risk for early mortality.


METHODS
This prospective cohort study of 147 patients in three hemodialysis dialysis units classified patients into "yes" and "no" groups on the basis of the "surprise" question response and tracked patient status (alive or dead) at 12 mo. Demographics, Charlson Comorbidity Index score, and Karnofsky Performance Status score were measured.


RESULTS
Initially, 34 (23%) patients were classified in the "no" group. Compared with the 113 patients in the "yes" group, the patients in the "no" group were older (72.5 +/- 12.8 versus 64.5 +/- 14.9), had a higher comorbidity score (7.1 +/- 2.3 versus 5.8 +/- 2.1), and had a lower performance status score (69.7 +/- 17.1 versus 81.6 +/- 15.8). At 12 mo, 22 (15%) patients had died; the mortality rate for the "no" group was 29.4% and for the "yes" group was 10.6%. The odds of dying within 1 yr for the patients in the "no" group were 3.5 times higher than for patients in the "yes" group, (odds ratio 3.507, 95% CI 1.356 to 9.067, P = 0.01).


CONCLUSIONS
The "surprise" question is effective in identifying sicker dialysis patients who have a high risk for early mortality and should receive priority for palliative care interventions.
Moss
Alvin H
AH
Section of Nephrology, Department of Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia 26506-9022, USA. amoss@hsc.wvu.edu
Ganjoo
Jesse
J
Sharma
Sanjay
S
Gansor
Julie
J
Senft
Sharon
S
Weaner
Barbara
B
Dalton
Cheryl
C
MacKay
Karen
K
Pellegrino
Beth
B
Anantharaman
Priya
P
Schmidt
Rebecca
R
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010166:Palliative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D014903:West Virginia / Q000453:epidemiology