SynthesisPalliative medicine2022
The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis.
Synthesis in Palliative medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 28 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prognostic utility of Palliative Prognostic Index in advanced cancer: A systematic review and meta-analysis.Palliative & supportive care · 2025Pooled it
- The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis.BMJ supportive & palliative care · 2024Pooled it
- Improving End-of-Life Screening in the Emergency Department With Collaborative Artificial Intelligence.Annals of emergency medicine · 2026Article
- Gender-sensitive and diversity-sensitive end-of-life care in Switzerland (GiveCare): a mixed-methods study protocol.BMJ open · 2026Article
- Translation and multi-site validation of the 'Pediatric Complex Care Needs Assessment Scale' (ACCAPED) from Italian to English.BMC palliative care · 2026Article
- Factors associated with a positive response to the surprise question in complex chronic patients treated by advanced practice nurses in primary care.BMC palliative care · 2026Article
- Implementing palliative reasoning in multiprofessional palliative care: A participatory action research in the Netherlands.PloS one · 2026Article
- Perceptions of deprescribing for patients with limited life expectancy in primary care.Primary health care research & development · 2025Article
- When would I be surprised? Variability in predicted probability of survival for being "surprised" and "not surprised" to the surprise question.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Article
- "Doctor, would it surprise you if there were prescribing errors in this patient's medication?" Identifying eligible patients for in-hospital pharmacotherapeutic stewardship: A matched case-control study.British journal of clinical pharmacology · 2025Article
- Analysis of the surprise question as a tool for predicting death in neonates.European journal of pediatrics · 2025Article
- Recruitment, follow-up and survival in an 11-country cohort study of patients at the end of life and their relatives.PloS one · 2025Article
- Challenges in the integration of palliative care for patients with hematologic malignancies: an analysis of the surprise question in a prospective cohort study.Sao Paulo medical journal = Revista paulista de medicina · 2025Article
- Promoting early goals of care conversations in the CICU with a surprise question-based EHR workflow.BMC palliative care · 2024Observational
- Factors influencing deprescribing in primary care for those towards the end of life: A qualitative interview study with patients and healthcare practitioners.Palliative medicine · 2024Article
- Factors Associated With Long Survival in Patients With Cancer Admitted to Palliative Care: An Exploratory Study.Journal of palliative care · 2024Article
- End-of-Life Care Preferences of Patients with Advanced Urological Malignancies: An Explorative Survey Study at a Tertiary Referral Center.Current oncology (Toronto, Ont.) · 2024Article
- The Surprise Question: Not Ready for Prime Time.Palliative medicine reports · 2024Article
- Palliative Care in Nursing Home Residents with Young-Onset Dementia: Professional and Family Caregiver Perspectives.Journal of Alzheimer's disease : JAD · 2024Observational
Corrections and comments
- Erratum issuedCorrigendum.2022
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe surprise question is widely used to identify patients nearing the last phase of life. Potential differences in accuracy between timeframe, patient subgroups and type of healthcare professionals answering the surprise question have been suggested. Recent studies might give new insights.
aimTo determine the accuracy of the surprise question in predicting death, differentiating by timeframe, patient subgroup and by type of healthcare professional.
designSystematic review and meta-analysis. DATA SOURCES: Electronic databases PubMed, Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched from inception till 22nd January 2021. Studies were eligible if they used the surprise question prospectively and assessed mortality. Sensitivity, specificity, negative predictive value, positive predictive value and c-statistic were calculated.
resultsFifty-nine studies met the inclusion criteria, including 88.268 assessments. The meta-analysis resulted in an estimated sensitivity of 71.4% (95% CI [66.3-76.4]) and specificity of 74.0% (95% CI [69.3-78.6]). The negative predictive value varied from 98.0% (95% CI [97.7-98.3]) to 88.6% (95% CI [87.1-90.0]) with a mortality rate of 5% and 25% respectively. The positive predictive value varied from 12.6% (95% CI [11.0-14.2]) with a mortality rate of 5% to 47.8% (95% CI [44.2-51.3]) with a mortality rate of 25%. Seven studies provided detailed information on different healthcare professionals answering the surprise question.
conclusionWe found overall reasonable test characteristics for the surprise question. Additionally, this study showed notable differences in performance within patient subgroups. However, we did not find an indication of notable differences between timeframe and healthcare professionals.
Indexed as
Identifiers
What OpenQuestion holds
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.