Evidence map›Paper›PMID 28385893›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017

The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis.

James Downar, Russell Goldman, Ruxandra Pinto, Marina Englesakis, Neill K J Adhikari

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05082389 (Prediction of Hospital Readmissions in SAPV), which is not on this map. Cited by 182 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
182citing papers in PubMed, 13 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05082389 completednot on this mapstarted 2021, after this paper: background citation

Prediction of Hospital Readmissions in SAPV (Specialised Home Palliative Care) Patients - Identification of Structural Factors and Support Needs of Family Caregivers

TypeobservationalSponsorTechnische Universität DresdenRan2021 to 2022Enrolled240ConditionsPalliative Care
3 · Its place in the literature

Who cites it

182 citing papers in PubMed, 13 syntheses or guidelines pooled it.

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122 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

James DownarDivisions of Respirology/Critical Care and Palliative Care, University Health Network; and Temmy Latner Centre for Palliative Care (Downar), Sinai Health System; Temmy Latner Centre for Palliative Care (Goldman), Sinai Health System; Department of Critical Care Medicine (Pinto), Sunnybrook Health Sciences Centre; Library and Information Services (Englesakis), University Health Network, Toronto General Hospital; Department of Critical Care Medicine (Adhikari) and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Adhikari), University of Toronto, Toronto, Ont. james.downar@utoronto.ca.
Russell GoldmanDivisions of Respirology/Critical Care and Palliative Care, University Health Network; and Temmy Latner Centre for Palliative Care (Downar), Sinai Health System; Temmy Latner Centre for Palliative Care (Goldman), Sinai Health System; Department of Critical Care Medicine (Pinto), Sunnybrook Health Sciences Centre; Library and Information Services (Englesakis), University Health Network, Toronto General Hospital; Department of Critical Care Medicine (Adhikari) and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Adhikari), University of Toronto, Toronto, Ont.
Ruxandra PintoDivisions of Respirology/Critical Care and Palliative Care, University Health Network; and Temmy Latner Centre for Palliative Care (Downar), Sinai Health System; Temmy Latner Centre for Palliative Care (Goldman), Sinai Health System; Department of Critical Care Medicine (Pinto), Sunnybrook Health Sciences Centre; Library and Information Services (Englesakis), University Health Network, Toronto General Hospital; Department of Critical Care Medicine (Adhikari) and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Adhikari), University of Toronto, Toronto, Ont.
Marina EnglesakisDivisions of Respirology/Critical Care and Palliative Care, University Health Network; and Temmy Latner Centre for Palliative Care (Downar), Sinai Health System; Temmy Latner Centre for Palliative Care (Goldman), Sinai Health System; Department of Critical Care Medicine (Pinto), Sunnybrook Health Sciences Centre; Library and Information Services (Englesakis), University Health Network, Toronto General Hospital; Department of Critical Care Medicine (Adhikari) and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Adhikari), University of Toronto, Toronto, Ont.
Neill K J AdhikariDivisions of Respirology/Critical Care and Palliative Care, University Health Network; and Temmy Latner Centre for Palliative Care (Downar), Sinai Health System; Temmy Latner Centre for Palliative Care (Goldman), Sinai Health System; Department of Critical Care Medicine (Pinto), Sunnybrook Health Sciences Centre; Library and Information Services (Englesakis), University Health Network, Toronto General Hospital; Department of Critical Care Medicine (Adhikari) and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Adhikari), University of Toronto, Toronto, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe surprise question - "Would I be surprised if this patient died in the next 12 months?" - has been used to identify patients at high risk of death who might benefit from palliative care services. Our objective was to systematically review the performance characteristics of the surprise question in predicting death.

methodsWe searched multiple electronic databases from inception to 2016 to identify studies that prospectively screened patients with the surprise question and reported on death at 6 to 18 months. We constructed models of hierarchical summary receiver operating characteristics (sROCs) to determine prognostic performance.

resultsSixteen studies (17 cohorts, 11 621 patients) met the selection criteria. For the outcome of death at 6 to 18 months, the pooled prognostic characteristics were sensitivity 67.0% (95% confidence interval [CI] 55.7%-76.7%), specificity 80.2% (73.3%-85.6%), positive likelihood ratio 3.4 (95% CI 2.8-4.1), negative likelihood ratio 0.41 (95% CI 0.32-0.54), positive predictive value 37.1% (95% CI 30.2%-44.6%) and negative predictive value 93.1% (95% CI 91.0%-94.8%). The surprise question had worse discrimination in patients with noncancer illness (area under sROC curve 0.77 [95% CI 0.73-0.81]) than in patients with cancer (area under sROC curve 0.83 [95% CI 0.79-0.87;

interpretationThe surprise question performs poorly to modestly as a predictive tool for death, with worse performance in noncancer illness. Further studies are needed to develop accurate tools to identify patients with palliative care needs and to assess the surprise question for this purpose.

Indexed as

DeathPredictive Value of TestsHumansModels, TheoreticalNeoplasmsPalliative CarePrognosisRandomized Controlled Trials as TopicROC Curve

Identifiers

PMID28385893
PMCPMC5378508

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.