IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v19y2022i3p1709-d740709.html
   My bibliography  Save this article

Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department

Author

Listed:
  • Laura Gaffney

    (Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
    Department of Palliative Care Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland)

  • Agnes Jonsson

    (Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland)

  • Conor Judge

    (Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
    Department of Palliative Care Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland)

  • Maria Costello

    (Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
    Department of Palliative Care Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland)

  • John O’Donnell

    (Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland)

  • Rónán O’Caoimh

    (Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
    Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland)

Abstract

The “surprise question” (SQ) predicts the need for palliative care. Its predictive validity for adverse healthcare outcomes and its association with frailty among older people attending the emergency department (ED) are unknown. We conducted a secondary analysis of a prospective study of consecutive patients aged ≥70 attending a university hospital’s ED. The SQ was scored by doctors before an independent comprehensive geriatric assessment (CGA). Outcomes included length of stay (LOS), frailty determined by CGA and one-year mortality. The SQ was available for 191 patients, whose median age was 79 ± 9. In all, 56/191 (29%) screened SQ positive. SQ positive patients were frailer; the median clinical frailty score was 6/9 (compared to 4/9, p < 0.001); they had longer LOS ( p = 0.008); and they had higher mortality ( p < 0.001). Being SQ positive was associated with 2.6 times greater odds of admission and 8.9 times odds of frailty. After adjustment for age, sex, frailty, co-morbidity and presenting complaint, patients who were SQ positive had significantly reduced survival times (hazard ratio 5.6; 95% CI: 1.39–22.3, p = 0.015). Almost one-third of older patients attending ED were identified as SQ positive. These were frailer and more likely to be admitted, have reduced survival times and have prolonged LOS. The SQ is useful to quickly stratify older patients likely to experience poor outcomes in ED.

Suggested Citation

  • Laura Gaffney & Agnes Jonsson & Conor Judge & Maria Costello & John O’Donnell & Rónán O’Caoimh, 2022. "Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department," IJERPH, MDPI, vol. 19(3), pages 1-11, February.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1709-:d:740709
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/19/3/1709/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/1660-4601/19/3/1709/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Rónán O’Caoimh & Maria Costello & Cliona Small & Lynn Spooner & Antoinette Flannery & Liam O’Reilly & Laura Heffernan & Edel Mannion & Anna Maughan & Alma Joyce & D. William Molloy & John O’Donnell, 2019. "Comparison of Frailty Screening Instruments in the Emergency Department," IJERPH, MDPI, vol. 16(19), pages 1-13, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Rónán O’Caoimh & Jane McGauran & Mark R. O’Donovan & Ciara Gillman & Anne O’Hea & Mary Hayes & Kieran O’Connor & Elizabeth Moloney & Megan Alcock, 2022. "Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7," IJERPH, MDPI, vol. 20(1), pages 1-13, December.
    2. Debbie Rand & Shelley A. Sternberg & Reut Gasner Winograd & Zvi Buckman & Netta Bentur, 2022. "The Contribution of Frailty to Participation of Older Adults," IJERPH, MDPI, vol. 19(3), pages 1-9, January.
    3. Elizabeth Moloney & Mark R. O’Donovan & Duygu Sezgin & Evelyn Flanagan & Keith McGrath & Suzanne Timmons & Rónán O’Caoimh, 2023. "Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 20(13), pages 1-18, July.
    4. Rónán O’Caoimh, 2023. "Validation of the Risk Instrument for Screening in the Community ( RISC ) among Older Adults in the Emergency Department," IJERPH, MDPI, vol. 20(4), pages 1-17, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1709-:d:740709. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.