Introduction: Alzheimer’s disease (AD) dementia is the sixth leading cause of death in the United States. The surprise question (SQ) “Would you be surprised if this patient were to die within the next 12 months?” was used to identify death-risk patients, who could benefit from palliative care. Objective: To examine the prognostic accuracy of the SQ by physicians and caregivers in outpatients with AD dementia. Methods: This is a longitudinal and prospective study involving 101 patients along 1 year, applying the SAS 9.2 software and adopting a .05 P-value to assess the variables that influenced answers to the accuracy of SQ using the chi-square test. Results: 27 patients (26.7%) died during the follow-up. When caregivers answered the SQ, it presented a 51.8% sensitivity (CI 31.9 - 71.3), a 66.7% negative predictive value (20.7 - 63.6), a 56.2% specificity (CI 29.8 - 80.2), and a 40.9% positive predictive value of (CI 43.0 - 85.4) with a 53.4% accuracy (CI 38.5 - 68.4). When physicians answered, the SQ had an 88.8% sensitivity (CI 70.8 - 97.6), a 40% negative predictive value (CI 5.2 - 85.3), a 12.5% specificity (CI 1.5 - 38.3), a 63.1% positive predictive value (CI 45.9 - 78.1) with a 60.4% accuracy (CI 45.8 - 75). Conclusion: SQ remains a good tool with high sensitivity for the identification of patients with advanced AD dementia when presented to the attending physician for planning palliative advanced care with accuracy of 60.4% and caregivers’ accuracy of 53.4%.
que acreditou no meu dom em ensinar, que me ajudou em momentos difíceis e que me mostrou, na prática, um modelo de verdadeiro docente e de pessoa admirável.Ao Prof. Antônio Carlos dos Santos, que participou com entusiasmo da pesquisa, que incentivou seu seguimento e facilitou sua execução, e que sempre se mostrou disponível em ajudar.Ao Dr. Marcelo de Freitas Mendonça, pelo incentivo dado no desenvolvimento da pesquisa, pela presteza em discutir questões relevantes e pelo apoio em sua execução.Aos médicos e amigos Dr. Sílvio Ramos Bernardes da Silva Filho, Dr. Eduardo Borges de Oliveira e Dr. Paulo Fernandes Formighieri, médicos assistentes que coordenam ambulatórios de geriatria no HCFMRP e possibilitaram o seguimento dos pacientes que necessitavam de acompanhamento ambulatorial após a pesquisa.
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