目的 评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web of Science等数据库,从建库至2023年11月所有有关安宁疗护筛查工具应用于急诊科患者的研究,由2名研究者独立进行文献筛选、资料提取和文献质量评价,采用Stata 15.0软件对资料数据进行Meta分析。结果 共纳入20篇文献,包含20 122例患者,一共涉及6种筛查工具,其中最常用的是惊讶问题（Surprise Questions,SQ）（n=9）,其次是急诊安宁疗护快速筛查工具（the Palliative Care and Rapid Emergency Screening,P-CaRES）（n=7）及急诊科姑息治疗和临终关怀需求筛查工具（the Screen for Palliative and End-of-life care needs in the Emergency Department,SPEED）（n=2）。9项研究通过评估SQ预测患者病死率从而确定安宁疗护需求,总体而言,SQ预测病死率的敏感度为0.72（0.59,0.82）,特异度为0.74（0.62,0.84）,均为中等。SQ预测长期病死率（1年内、2年内）的敏感度0.75（0.64,0.84）高于预测短期病死率（1个月内、3个月内）的敏感度0.65（0.35,0.86）。此外,就1年内急诊入院或频繁急诊科就诊而言,SQ敏感度为0.72（0.41,0.90）、特异度为0.52（0.32,0.72）。P-CaRES预测安宁疗护需求合并敏感度为0.73（0.57,0.85）、特异度为0.64（0.48,0.77）。结论 用于急诊科安宁疗护筛查的工具中SQ应用最广泛,其次是P-CaRES,两种工具在预测患者未来1年病死率方面均具有中等敏感度和特异度,但该结论仍需高质量、大样本研究进一步验证。
Objective To evaluate the accuracy of commonly used hospice screening tools to identify hospice needs of emergency department patients. Methods We searched CNKI,Wanfang Database,China Biomedical Literature Database,PubMed,Cochrane Library,Embase,CINAHL,and Web of Science for all studies on hospice screening tools applied to emergency department patients from the time of database construction to November 2023,and two researchers independently performed literature screening,data extraction,and literature quality evaluation,and Stata 15.0 software was used to perform meta-analysis of the profile data. Results A total of 20 papers were included,containing 20,122 patients,involving a total of 6 screening tools,of which the most commonly used was the Surprise Questions（SQ;n=9）,followed by the Palliative Care and Rapid Emergency Screening（P-CaRES;n=7） and the Screen for Palliative and End-of-life care needs in the Emergency Department（SPEED;n=2）. 9 studies identified hospice needs by assessing the SQ for predicting patient mortality. Overall,the sensitivity of the SQ for predicting mortality was moderate at 0.72（0.59,0.82） and the specificity was moderate at 0.74（0.62,0.84）.The sensitivity of the SQ for predicting long-term mortality（within 1 year,2 years） was higher at 0.75（0.64,0.84） than the sensitivity of the SQ for predicting short-term mortality（within 1 month,within 3 months） of 0.65（0.35,0.86）. In addition,for emergency admissions or frequent emergency department visits within 1 year,SQ sensitivity was 0.72（0.41,0.90） and specificity was 0.52（0.32,0.72）.P-CaRES predicted mortality with a sensitivity of 0.73（0.57,0.85） and specificity of 0.64（0.48,0.77）. Conclusion The SQ is the most widely used tool for hospice screening in the emergency department,followed by the P-CaRES,and they both have moderate sensitivity and specificity in predicting patient mortality in the next one year,the conclusion that still requires further validation in high-quality,large-sample studies.
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