Response to “The Surprise Question in Older Hospitalized Patients”

The recent research letter on the use of the Surprise Question1 asserted that the research reported was intended to “establish the predictive validity of the Surprise Question in older hospitalized patients.” The findings reported may be useful in various ways, but the test of the predictive validity of the Surprise Question is not whether the patients actually died within a year, once identified by having clinicians who would not be surprised if they did so. The Surprise Question aims to identify patients in a precarious balance with their physiology, so that a small perturbation in their health might well lead to death.