Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest

Abstract

Background Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition are commonly used to determine outcomes following cardiac arrest. This study tested the association between these outcome measures. Methods Retrospective chart review of subjects who survived to hospital discharge between 1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS, and discharge disposition). Discharge disposition was classified in 6 categories: home with no services, home with home healthcare, acute rehabilitation facility, skilled nursing facility, long term acute care facility, and hospice. Intra-and inter-rater reliabilities were calculated for outcome measures. Rates of “good outcome” (defined as a CPC of 1–2, mRS of 0–3, or discharge disposition to home or acute rehabilitation facility) were also determined. Kendall’s tau correlation coefficients explored relationships among measures. Results A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%) were white males, in- and out-of hospital cardiac arrests were equally prevalent, and ventricular dysrhythmia was most common (N=109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%) received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS abstraction was 95.24% (kappa 0.89, p<0.001) and 95.24% (kappa 0.90, p<0.001) respectively. “Good outcomes” were found in 44 subjects (20%) using the CPC definition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects using discharge disposition definition. There was fair relationship between the CPC and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau 0.23) and between mRS and discharge disposition (tau 0.25). Conclusions Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable from chart review. These instruments provide widely differing estimates of “good outcome.” Agreement between these measures ranges from poor to fair. A more nuanced outcome measure designed for the post-cardiac arrest population is needed.

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

“…Our finding is consistent with a previous study in which caregiver's psychological morbidity was equal to or greater than the patient's (Xian et al, 2011). In another previous study, almost 40% of the spouse caregivers reported depressive symptoms in a range that was likely to be clinically significant, a prevalence that was almost two-fold than their ill partners (Rittenberger et al, 2011). Previous studies have demonstrated that caregivers of patients with cancer have increased health problems and psychosocial stress (Bergen-Jackson et al, 2009;Kiely et al, 2010;Zhou et al, 2010;Bell et al, 2011;Gilbertson-White et al, 2011;Legler et al, 2011;Stevens et al, 2011).…”

“…There were some studies about burden of caregivers of terminally ill patients (Bekelman et al, 2011;Nelson et al, 2011;Rittenberger et al, 2011;Xian et al, 2011). However, to our knowledge, there had been few studies to compare burden of terminal cancer patients and their caregivers.…”

Hyperattenuated Intracerebral Lesions after Mechanical Recanalization in Acute Stroke

“…For this reason mRS ϭ 3 was still considered a good outcome when dichotomizing the scale. 10 Among factors for good clinical outcome, time from onset of symptoms to recanalization is considered one of the key factors, with an increasing time span to recanalization decreasing the chances of success for the rescue of tissue at risk. 22 In our investigation, various time factors were assessed but, as shown in previous investigations, did not show a statistically significant influence on clinical outcome.…”

Does the number of rescuers affect the survival rate from out-of-hospital cardiac arrests? Two or more rescuers are not always better than one

“…The collected data were based on the Utstein template [15,16] and included the region, place, patient's age, patient's sex, arrest witness, causes of arrest (presumed cardiac or not), bystander CPR, initial cardiac rhythm, estimated time of collapse, times of the initiation of CPR by bystanders and EMTs, interval between the emergency call and arrival at the patient, sustained return of spontaneous circulation (SROSC), one-month (1-M) survival, one-year (1-Y) survival and 1-Y survival with a favourable neurological outcome, determined based on the Pittsburgh cerebral performance category (CPC) [17,18]. The times of collapse and the initiation of CPR by bystanders were estimated by an interview, as reported previously [4].…”