The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians
Background The ‘surprise question’ (SQ) asks care professionals to assess the patient’s mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ3/SQ12) answered by nurses and physicians in unselected adult emergency depar...
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Taylor & Francis Group
2025-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2025.2529575 |
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| author | Maurice Theunissen Sacha Lardenoye Marieke H. J. van den Beuken-van Everdingen Patricia M. Stassen |
| author_facet | Maurice Theunissen Sacha Lardenoye Marieke H. J. van den Beuken-van Everdingen Patricia M. Stassen |
| author_sort | Maurice Theunissen |
| collection | DOAJ |
| description | Background The ‘surprise question’ (SQ) asks care professionals to assess the patient’s mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ3/SQ12) answered by nurses and physicians in unselected adult emergency department (ED) patients, and in high risk subgroups (age ≥ 50 y; medical patients), 2) the agreement between these care professionals.Patients and methods In this prospective study, the SQ3 and SQ12 were scored by nurses and physicians. AU-ROC, sensitivity, specificity, and negative predictive value (NPV) were calculated.Kappa values and absolute agreement were calculated.Results In total, 1958 patients were assessed. Mortality within 12 months was 13.9% in all patients (8.3% within 3 months), 22.9% in older and 20.1% in medical patients. The AU-ROC of the SQ3 was 0.639 and 0.698 for nurses and physicians, resp., and that of the SQ12 was 0.722 and 0.847, resp. For SQ3, sensitivity was 46.8–48.0%, and specificity 93.9–95.1%, with high NPV (95.6–97.0%). For SQ12, sensitivity was higher (54.1–60.8%), with specificity of 83.4–96.4%, and high NPV. AU-ROCs for the two high risk subgroups were comparable. Agreement was fair (kappa 0.255) for SQ3, and moderate (kappa 0.461) for SQ12, while absolute agreement was 91.4% and 80.5%, resp.Conclusions The study supports the SQ as a simple prognostic tool in the ED, with 12-month prognostic accuracy being especially reliable in high-risk patients. The agreement between nurses and physicians was fair-moderate. The SQ could play an important role in guiding ED care, especially in high-risk patients. |
| format | Article |
| id | doaj-art-63fb599a9e5949028aa09bd5ba3cc172 |
| institution | DOAJ |
| issn | 0785-3890 1365-2060 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj-art-63fb599a9e5949028aa09bd5ba3cc1722025-08-20T03:13:11ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2529575The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physiciansMaurice Theunissen0Sacha Lardenoye1Marieke H. J. van den Beuken-van Everdingen2Patricia M. Stassen3Center of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Emergency Medicine, Maastricht University Medical Center, Maastricht, The NetherlandsCenter of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht, The NetherlandsBackground The ‘surprise question’ (SQ) asks care professionals to assess the patient’s mortality risk. In this prospective study, we investigated 1) the prognostic accuracy of the SQ regarding 3- and 12-month mortality (SQ3/SQ12) answered by nurses and physicians in unselected adult emergency department (ED) patients, and in high risk subgroups (age ≥ 50 y; medical patients), 2) the agreement between these care professionals.Patients and methods In this prospective study, the SQ3 and SQ12 were scored by nurses and physicians. AU-ROC, sensitivity, specificity, and negative predictive value (NPV) were calculated.Kappa values and absolute agreement were calculated.Results In total, 1958 patients were assessed. Mortality within 12 months was 13.9% in all patients (8.3% within 3 months), 22.9% in older and 20.1% in medical patients. The AU-ROC of the SQ3 was 0.639 and 0.698 for nurses and physicians, resp., and that of the SQ12 was 0.722 and 0.847, resp. For SQ3, sensitivity was 46.8–48.0%, and specificity 93.9–95.1%, with high NPV (95.6–97.0%). For SQ12, sensitivity was higher (54.1–60.8%), with specificity of 83.4–96.4%, and high NPV. AU-ROCs for the two high risk subgroups were comparable. Agreement was fair (kappa 0.255) for SQ3, and moderate (kappa 0.461) for SQ12, while absolute agreement was 91.4% and 80.5%, resp.Conclusions The study supports the SQ as a simple prognostic tool in the ED, with 12-month prognostic accuracy being especially reliable in high-risk patients. The agreement between nurses and physicians was fair-moderate. The SQ could play an important role in guiding ED care, especially in high-risk patients.https://www.tandfonline.com/doi/10.1080/07853890.2025.2529575Surprise questionpredictive accuracyemergency department |
| spellingShingle | Maurice Theunissen Sacha Lardenoye Marieke H. J. van den Beuken-van Everdingen Patricia M. Stassen The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians Annals of Medicine Surprise question predictive accuracy emergency department |
| title | The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians |
| title_full | The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians |
| title_fullStr | The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians |
| title_full_unstemmed | The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians |
| title_short | The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians |
| title_sort | surprise question predictive accuracy in an unselected emergency department population a prospective study in nurses and physicians |
| topic | Surprise question predictive accuracy emergency department |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2025.2529575 |
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