Background and objectives: Dialysis patients are increasingly characterized by older age, multiple comorbidities, and shortened life expectancy. This study investigated whether the "surprise" question, "Would I be surprised if this patient died in the next year?" identifies patients who are at high risk for early mortality.Design, setting, participants, & measurements: This prospective cohort study of 147 patients in three hemodialysis dialysis units classified patients into "yes" and "no" groups on the basis of the ؆surprise؆ question response and tracked patient status (alive or dead) at 12 mo. Demographics, Charlson Comorbidity Index score, and Karnofsky Performance Status score were measured.Results: Initially, 34 (23%) patients were classified in the "no" group. Compared with the 113 patients in the "yes" group, the patients in the "no" group were older (72.5 ؎ 12.8 versus 64.5 ؎ 14.9), had a higher comorbidity score (7.1 ؎ 2.3 versus 5.8 ؎ 2.1), and had a lower performance status score (69.7 ؎ 17.1 versus 81.6 ؎ 15.8). At 12 mo, 22 (15%) patients had died; the mortality rate for the "no" group was 29.4% and for the "yes" group was 10.6%. The odds of dying within 1 yr for the patients in the "no" group were 3.5 times higher than for patients in the "yes" group, (odds ratio 3.507, 95% CI 1.356 to 9.067, P ؍ 0.01).Conclusions: The ؆surprise؆ question is effective in identifying sicker dialysis patients who have a high risk for early mortality and should receive priority for palliative care interventions.
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