Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department

Abstract

BackgroundEarly brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians’ interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM).MethodsThis was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups.ResultsOf the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48–0.83), which showed a good conformity.ConclusionsThe emergency physicians’ interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.

Preserving Brain LPC‐DHA by Plasma Supplementation Attenuates Brain Injury after Cardiac Arrest

“…Clinical data were collected retrospectively from electronic medical charts. The gray to white matter signal intensity ratio (GWR) was analyzed using brain computed tomography (CT) images of 17 patients with CA in a blinded manner using a previously described method 17,18 . The CT scan was performed within 8 hours after ROSC.…”

“…The CT scan was performed within 8 hours after ROSC. Based on our previous study, the cutoff point of 1.15 of GWR was used for dichromating 18,19 . The Cerebral Performance Categories (CPC) at hospital discharge were used to determine neurological outcome of the patients 20 .…”

Targeted temperature management and early neuro-prognostication after cardiac arrest

“…123 Of note, the interpretation of early post-CA CT scans by emergency physicians and radiologists showed acceptable inter-rater reliability (Kappa statistics: 0.66). 124 In contrast, another study showed that interobserver variability when identifying ischemic brain injury was moderate to high (kappa statistics: 0.0–0.48) on head CT scans obtained from adults within two hours of resuscitation from out-of-hospital cardiac arrest. 125 In addition, using specialized scoring systems, extensive anoxic brain injury revealed by early CT (performed before the initiation of TTM) was associated with unfavorable outcome.…”

Critérios prognósticos: paciente comatoso e controle direcionado de temperatura

“…Um dos trabalhos investigou o potencial papel prognóstico de uma tomografia precoce, ainda na sala de emergência, buscando identificar sinais de encefalopatia isquêmica em pacientes que posteriormente foram submetidos a CDT 19 . A presença de sinais como a perda de diferenciação entre substância branca e cinzenta ou edema cerebral foi capaz de predizer desfechos neurológicos ruins com acurácia de 1,00, isto é, probabilidade extremamente baixa de boa recuperação neurológica 19 .…”