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

Laura Gaffney, Agnes Jonsson, Conor Judge, Maria Costello, John O’Donnell and Rónán O’Caoimh
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Laura Gaffney: Department of Geriatric and Stroke 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
Maria Costello: Department of Geriatric and Stroke 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

IJERPH, 2022, vol. 19, issue 3, 1-11

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.

Keywords: older adults; frailty; geriatric patient; healthcare outcomes; emergency department; palliative care; quality of life; geriatric assessment; COVID-19 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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