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Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study
  1. Alison M Mudge1,2,
  2. Carol Douglas3,
  3. Xanthe Sansome4,
  4. Michael Tresillian1,
  5. Stephen Murray1,
  6. Simon Finnigan4,5 and
  7. Cheryl Ruth Blaber3
  1. 1Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
  2. 2Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  3. 3Palliative and Supportive Care Services, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
  4. 4Internal Medicine Research Unit, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
  5. 5UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Dr Alison M Mudge, Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; Alison.Mudge{at}


Objectives People with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality.

Methods Prospective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients. Data sources included medical record and structured questions for medical and nursing staff. High-risk was predefined as positive response to the surprise question (SQ) plus two or more SPICT indicators of general deterioration. Descriptive variables included demographics, frailty and functional measures, treating team, advance care planning documentation and hospital utilisation. Primary outcome for prognostic performance was 12-month mortality.

Results We identified 540 eligible inpatients on the study day and 513 had complete data (mean age 60, 54% male, 30% living alone, 19% elective admissions). Of these, 191 (37%) were high-risk; they were older, frailer, more dependent and had been in hospital longer than low-risk participants. Within 12 months, 92 participants (18%) died (72/191(38%) high-risk versus 20/322(6%) low-risk, P<0.001), providing sensitivity 78%, specificity 72%, positive predictive value 38% and negative predictive value 94%. SQ alone provided higher sensitivity, adding advanced disease indicators improved specificity.

Conclusions The GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals.

  • advance care planning
  • death
  • prognosis
  • decision support techniques
  • hospitals

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  • Contributors CD, CRB, AMM and XS conceived the study. AMM and MT drafted the article. XS, SM, MT and SF made substantial contributions to acquisition and analysis of data. All authors contributed to critical revision of the article and approved the version to be published.

  • Funding The study was funded by a SEED Innovation grant from the Metro North Hospitals and Health Service. Funders had no role in study conduct, data analysis, publication drafting or the decision to submit.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was received from the RBWH Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Permissions for data sharing have not been granted.