title: Utility of the "surprise" question to identify dialysis patients with high mortality.
abstract: 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.
authors.affiliation: Section of Nephrology, Department of Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia 26506-9022, USA. amoss@hsc.wvu.edu
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Moss
authors.forename: Jesse
authors.initials: J
authors.lastname: Ganjoo
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Julie
authors.initials: J
authors.lastname: Gansor
authors.forename: Sharon
authors.initials: S
authors.lastname: Senft
authors.forename: Barbara
authors.initials: B
authors.lastname: Weaner
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dalton
authors.forename: Karen
authors.initials: K
authors.lastname: MacKay
authors.forename: Beth
authors.initials: B
authors.lastname: Pellegrino
authors.forename: Priya
authors.initials: P
authors.lastname: Anantharaman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schmidt
mesh_terms: 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