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Article

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

by
Laura Gaffney
1,2,
Agnes Jonsson
3,
Conor Judge
1,2,
Maria Costello
1,2,
John O’Donnell
4 and
Rónán O’Caoimh
1,3,*
1
Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
2
Department of Palliative Care Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
3
Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
4
Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway, Ireland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(3), 1709; https://doi.org/10.3390/ijerph19031709
Submission received: 31 December 2021 / Revised: 23 January 2022 / Accepted: 25 January 2022 / Published: 2 February 2022
(This article belongs to the Special Issue Frailty in the Elderly: Issues and Challenges)
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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 older adults; frailty; geriatric patient; healthcare outcomes; emergency department; palliative care; quality of life; geriatric assessment; COVID-19

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MDPI and ACS Style

Gaffney, L.; Jonsson, A.; Judge, C.; Costello, M.; O’Donnell, J.; O’Caoimh, R. Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department. Int. J. Environ. Res. Public Health 2022, 19, 1709. https://doi.org/10.3390/ijerph19031709

AMA Style

Gaffney L, Jonsson A, Judge C, Costello M, O’Donnell J, O’Caoimh R. Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department. International Journal of Environmental Research and Public Health. 2022; 19(3):1709. https://doi.org/10.3390/ijerph19031709

Chicago/Turabian Style

Gaffney, Laura, Agnes Jonsson, Conor Judge, Maria Costello, John O’Donnell, and Rónán O’Caoimh. 2022. "Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department" International Journal of Environmental Research and Public Health 19, no. 3: 1709. https://doi.org/10.3390/ijerph19031709

APA Style

Gaffney, L., Jonsson, A., Judge, C., Costello, M., O’Donnell, J., & O’Caoimh, R. (2022). Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department. International Journal of Environmental Research and Public Health, 19(3), 1709. https://doi.org/10.3390/ijerph19031709

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