External Validation of the Simple NULL-PLEASE Clinical Score in Predicting Outcome of Out-of-Hospital Cardiac Arrest

Potpara, Tatjana; Mihajlović, M; Stanković, Sanja; Jozić, Tanja; Jozić, Irena; Ašanin, Milika; Ahmad, Rajai; Lip, Gregory Y.H.

doi:10.1016/j.amjmed.2017.05.035

Cited by 30 publications

(29 citation statements)

References 19 publications

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“…In comparison, both the OHCA and Cardiac Arrest Hospital Prognosis scores are difficult to calculate, needing advanced calculator functions, or nomograms, and are neither easy to calculate, nor clinically friendly. Our results support and extend the findings of the initial validation of the NULL-PLEASE score for death in the emergency department in a small cohort, 14 to now predict survival to hospital discharge, in a large independent cohort, with subsequent validation. Because some 55% of OHCAs are attributable to a cardiac cause, 17 the strong performance of the score in this subgroup is highly pertinent.…”

Section: Discussionsupporting

confidence: 84%

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Usefulness of the NULL-PLEASE Score to Predict Survival in Out-of-Hospital Cardiac Arrest

Gue

Sayers²,

Whitby

et al. 2020

The American Journal of Medicine

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Out-of-hospital cardiac arrest (OHCA) carries a very high mortality rate even after successful cardiopulmonary resuscitation. Currently, information given to relatives about prognosis following resuscitation is often emotive and subjective, and varies with clinician experience. We aimed to validate the NULL-PLEASE score to predict survival following OHCA. METHODS: A multicenter cohort study was conducted, with retrospective and prospective validation in consecutive unselected patients presenting with OHCA. The NULL-PLEASE score was calculated by attributing points to the following variables: Nonshockable initial rhythm, Unwitnessed arrest, Long lowflow period, Long no-flow period, pH <7.2, Lactate >7.0 mmol/L, End-stage renal failure, Age ≥85 years, Still resuscitation, and Extracardiac cause. The primary outcome was in-hospital death. RESULTS: We assessed 700 patients admitted with OHCA, of whom 47% survived to discharge. In 300 patients we performed a retrospective validation, followed by prospective validation in 400 patients. The NULL-PLEASE score was lower in patients who survived compared with those who died (0 [interquartile range 0-1] vs 4 [interquartile range 2-4], P < .0005) and strongly predictive of in-hospital death (C-statistic 0.874; 95% confidence interval, 0.848-0.899). Patients with a score ≥3 had a 24-fold increased risk of death (odds ratio 23.6; 95% confidence interval, 14.840-37.5; P < .0005) compared with those with lower scores. A score ≥3 has a 91% positive predictive value for in-hospital death, while a score <3 predicts a 71% chance of survival. CONCLUSION: The easy-to-use NULL-PLEASE score predicts in-hospital mortality with high specificity and can help clinicians explain the prognosis to relatives in an easy-to-understand, objective fashion, to realistically prepare them for the future.

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Section: Discussionsupporting

confidence: 84%

“…The score has only been validated to predict death in the emergency department, with a C-statistic of 0.658. 14 Its usefulness for predicting survival in the hospital has not been assessed.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of the NULL-PLEASE Score to Predict Survival in Out-of-Hospital Cardiac Arrest

Gue

Sayers²,

Whitby

et al. 2020

The American Journal of Medicine

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“…Previous studies comparably identified no-and low-flow time as significant prognostic factors in cardiac arrest [3,[28][29][30][31]. However, data on no-and low-flow times are often estimations or unknown and have been shown to be inaccurate [32].…”

Section: Discussionmentioning

confidence: 99%

Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest

Buchtele

Schober

Schoergenhofer

et al. 2018

European Journal of Internal Medicine

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“…Therefore, they cannot be applied to patients without witnesses of cardiac arrest [4,6]. The "nonshockable rhythm, unwitnessed arrest, long no-ow or long low-ow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause" (NULL-PLEASE) clinical score was devised to identify patients unlikely to survive out-of-hospital cardiac arrest using several unfavorable cardiac arrest-or patient-related characteristics [7]. Recently, the postcardiac arrest syndrome for therapeutic hypothermia (CAST) score and revised CAST (rCAST) score were developed to predict the neurologic prognosis in patients after resuscitation following cardiac arrest, prior to inducing therapeutic hypothermia [10,11].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous External Validation of Various Cardiac Arrest Prognostic Scores: a Single-center Retrospective Study

Tsuchida

Ono²,

Maekawa

et al. 2021

Preprint

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Background: This study aimed to compare and validate the out-of-hospital cardiac arrest (OHCA); cardiac arrest hospital prognosis (CAHP); non-shockable rhythm, unwitnessed arrest, long no-flow or long low-flow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause (NULL-PLEASE) clinical; post-cardiac arrest syndrome for therapeutic hypothermia (CAST); and revised CAST (rCAST) scores in OHCA patients treated with recent cardiopulmonary resuscitation strategies.Methods: We retrospectively collected data on adult OHCA patients admitted to our emergency department between February 2015 and July 2018. OHCA, CAHP, NULL-PLEASE clinical, CAST, and rCAST scores were calculated based on the data collected. The predictive abilities of each score were tested using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results: We identified 236 OHCA patients from computer-based medical records and analyzed 189 without missing data. In OHCA patients without bystander witnesses, CAHP and OHCA scores were not calculated. Although the predictive abilities of the scores were not significantly different, the NULL-PLEASE score had a large AUC of ROC curve in various OHCA patients. Furthermore, in patients with bystander-witnessed OHCA, the NULL-PLEASE score had large partial AUCs of ROC from sensitivity 0.8 to 1.0 and specificity 0.8 to 1.0. Conclusions: The NULL-PLEASE score had a high, comprehensive predictive ability in various OHCA patients. Furthermore, the NULL-PLEASE score had a high predictive ability for good and poor neurological outcomes in patients with bystander-witnessed OHCA.

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External Validation of the Simple NULL-PLEASE Clinical Score in Predicting Outcome of Out-of-Hospital Cardiac Arrest

Abstract: The NULL-PLEASE score was predictive for early in-hospital outcome of out-of-hospital cardiac arrest, with a 3.3-fold greater odds for fatal outcome at the score values of ≥5.

Cited by 30 publications

References 19 publications

Usefulness of the NULL-PLEASE Score to Predict Survival in Out-of-Hospital Cardiac Arrest

Usefulness of the NULL-PLEASE Score to Predict Survival in Out-of-Hospital Cardiac Arrest

Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest

Simultaneous External Validation of Various Cardiac Arrest Prognostic Scores: a Single-center Retrospective Study

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