The Surprise Question as a Trigger for Primary Palliative Care Interventions for Children with Advanced Heart Disease

Title

The Surprise Question as a Trigger for Primary Palliative Care Interventions for Children with Advanced Heart Disease

Creator

Alizadeh F; Morell E; Hummel K; Wu Y; Wypij D; Matthew D; Esteso P; Moynihan K; Blume ED

Publisher

Pediatric Cardiology

Date

2022

Subject

Pediatric palliative care; Advanced care planning; Advanced heart disease; Pediatric cardiology; Prognostication; Surprise question

Description

There is significant uncertainty in describing prognosis and a lack of reliable entry criteria for palliative care studies in children with advanced heart disease (AHD). This study evaluates the utility of the surprise question-"Would you be surprised if this child died within the next year?"-to predict one-year mortality in children with AHD and assess its utility as entry criteria for future trials. This is a prospective cohort study of physicians and nurses caring for children (1 month-19 years) with AHD hospitalized ≥ 7 days. AHD was defined as single ventricle physiology, pulmonary vein stenosis or pulmonary hypertension, or any cardiac diagnosis with signs of advanced disease. Primary physicians were asked the surprise question and medical record review was performed. Forty-nine physicians responded to the surprise question for 152 patients. Physicians responded "No, I would not be surprised if this patient died" for 54 (36%) patients, 20 (37%) of whom died within 1 year, predicting one-year mortality with 77% sensitivity, 73% specificity, 37% positive predictive value, and 94% negative predictive value. Patients who received a "No" response had an increased 1-year risk of death (hazard ratio 7.25, p < 0.001). Physician years of experience, subspecialty, and self-rated competency were not associated with the accuracy of the surprise question. The surprise question offers promise as a bedside screening tool to identify children with AHD at high risk for mortality and help physicians identify patients who may benefit from palliative care and advance care planning discussions.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

August 2022 List

Collection

Citation

Alizadeh F; Morell E; Hummel K; Wu Y; Wypij D; Matthew D; Esteso P; Moynihan K; Blume ED, “The Surprise Question as a Trigger for Primary Palliative Care Interventions for Children with Advanced Heart Disease,” Pediatric Palliative Care Library, accessed November 28, 2022, https://pedpalascnetlibrary.omeka.net/items/show/18161.

Social Bookmarking