Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score

Piscator, Eva; Göransson, Katarina E.; Bruchfeld, Samuel; Hammar, Ulf; Gharbi, Sara El; Ebell, Mark H.; Herlitz, Johan; Djärv, Therese

doi:10.1016/j.resuscitation.2018.04.035

Cited by 32 publications

(42 citation statements)

References 33 publications

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“…Frailty per se was not assessed when constructing the model, but factors consistent with frailty were examined, such as admission from a skilled nursing facility, which was included in the final model and carried considerable weight. 14,15 Almost 30% of frail patients in this study had a Charlson index of comorbidity of zero, consistent with previous work that found frailty occurs in around a quarter of patients in the absence of comorbid disease and disability. 16…”

Section: Relationship To Previous Worksupporting

confidence: 90%

“…The Ebell‐led group also developed of the Good Outcome Following Attempted Resuscitation Score, an instrument for identifying patients unlikely to achieve neurologically intact survival after in‐hospital resuscitation. Frailty per se was not assessed when constructing the model, but factors consistent with frailty were examined, such as admission from a skilled nursing facility, which was included in the final model and carried considerable weight …”

Section: Discussionmentioning

confidence: 99%

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Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Smith

Reid

Santamaria

2019

Internal Medicine Journal

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Background Frailty is common among acute hospital patients and might adversely affect recovery from inpatient cardiac arrest. Aim To assess the relationship between hospital admission characteristics, including frailty, and discharge outcome after in‐hospital cardiac arrest. Methods Prospectively collected data were retrospectively analysed for all separations from a tertiary hospital during 2008–2017 that involved rapid response team attendance for cardiac arrest. Hospital Frailty Risk Score (HFRS) and Charlson index of comorbidity were calculated from ‘primary’ and ‘associated’ International Classification of Diseases, 10th revision, Australian Modification diagnoses. HFRS ≥5 was taken to signify frailty. Discharge home from hospital and death in hospital were modelled using logistic regression. Results There were 388 in‐hospital arrest patients: 91% were aged ≥50 years, 34% were previously discharged in the past 6 months, 66% were unplanned admissions, 63% were non‐cardiology‐cardiothoracic admissions, 45% had a Charlson comorbidity index ≥2 and 19% were identified as frail. Discharge home occurred in 22%, discharge to another hospital 17% and death 62%. Of the frail patients, only 3 (4%) were discharged home, 12 (17%) were discharged to another hospital and 57 (79%) died in hospital. Fewer frail patients were discharged home compared with non‐frail patients (4 vs 26%; odds ratio (OR) 0.13, P = 0.001). On multivariable analysis, patients were less likely to be discharged home if they had frailty (OR 0.24, P = 0.02), age ≥ 50 years (OR 0.36, P = 0.01), non‐cardiology‐cardiothoracic unit admission (OR 0.40, P = 0.001) and unplanned admission (OR 0.57, P = 0.04). Frail patients discharged to another hospital spent a median of 15 days (interquartile range 11–23) in the hospital post‐arrest before leaving to continue inpatient care elsewhere. Frailty was associated with death in hospital on univariate analysis (79 vs 58%; OR 2.80, P = 0.001) but not after controlling for other factors. Conclusion Frail patients are unlikely to make a good recovery after in‐hospital arrest. This should be taken into account when planning care with patients and their families.

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Section: Relationship To Previous Worksupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Smith

Reid

Santamaria

2019

Internal Medicine Journal

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“…In addition, our overall survival rate to discharge was significantly higher than the original US study 8 (CID 14.5%, 95% CI 9.9 to 19.1%) and the Skåne University study 9 (CID 12.7%, 95% CI 6.2 to 19.3%). Similar to the two previous external validation studies in Sweden, 9,10 our proportion of patients with survival to discharge with good neurologic outcome (CID 7.0%, 95% CI 3.2 to 10.6%) was significantly higher than reported in the original US study. We compared our rates of survival with good neurologic outcome (CPC = 1) grouped by GO-FAR score category with those in the Swedish and original derivation studies (Table 4).…”

Section: Resultssupporting

confidence: 88%

“…Demographic characteristics of our study population compared with those in the three previous studies using the GO-FAR score [8][9][10] are shown in Table 3. Compared with these studies, our patients had a lower mean age (60.3 years, 95% CI 58.4 to 61.6) and a slightly higher proportion were male (65.5%, 95% CI 61 to 70%).…”

Section: Resultsmentioning

confidence: 99%

“…8 Using 13 variables (Table 1), the GO-FAR score accurately predicted the likelihood of survival to discharge with good neurologic outcome following IHCA in the internal validation split sample. Since this publication, two studies in Sweden (287 adults with IHCA in 2007-2010 at Skåne University Hospital 9 and 717 adults with IHCA in 2013-2014 in six hospitals in Stockholm County 10 ) have externally validated the utility of the GO-FAR score. In this study, we not only report the first external validation in a US hospital of the GO-FAR score for predicting patient outcomes after IHCA events but also investigate its performance when calculating the score at the time of admission.…”

Section: Introductionmentioning

confidence: 99%

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Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted Resuscitation Score

2019

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BACKGROUND: Providers should estimate a patient's chance of surviving an in-hospital cardiac arrest with good neurologic outcome when initially admitting a patient, in order to participate in shared decision making with patients about their code status. OBJECTIVE: To examine the utility of the "Good Outcome Following Attempted Resuscitation (GO-FAR)" score in predicting prognosis after in-hospital cardiac arrest in a US trauma center. DESIGN: Retrospective observational study SETTING: Level 1 trauma and academic hospital in Minneapolis, MN, USA PARTICIPANTS: All cases of pulseless in-hospital cardiac arrest occurring in adults (18 years or older) admitted to the hospital between Jan 2009 and Sept 2018 are included. For patients with more than one arrest, only the first was included in this analysis. MAIN MEASURES: For each patient with verified inhospital cardiac arrest, we calculated a GO-FAR score based on variables present in the electronic health record at time of admission. Pre-determined outcomes included survival to discharge and survival to discharge with good neurologic outcome. KEY RESULTS: From 2009 to 2018, 403 adults suffered in-hospital cardiac arrest. A majority (65.5%) were male with a mean age of 60.3 years. Overall survival to discharge was 33.0%; survival to discharge with good neurologic outcome was 17.4%. GO-FAR score calculated at the time of admission correlated with survival to discharge with good neurologic outcome (AUC 0.68), which occurred in 5.3% of patients with below average survival likelihood by GO-FAR score, 22.5% with average survival likelihood, and 34.1% with above average survival likelihood. CONCLUSIONS: The GO-FAR score can estimate, at time of admission to the hospital, the probability that a patient will survive to discharge with good neurologic outcome after an in-hospital cardiac arrest. This prognostic information can help providers frame discussions with patients on admission regarding whether to attempt cardiopulmonary resuscitation in the event of cardiac arrest.

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Predicting the probability of good neurological outcome after in-hospital cardiac arrest based on prearrest factors: validation of the good outcome following attempted resuscitation 2 (GO-FAR 2) score

et al. 2023

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Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score

Cited by 32 publications

References 33 publications

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted Resuscitation Score

Predicting the probability of good neurological outcome after in-hospital cardiac arrest based on prearrest factors: validation of the good outcome following attempted resuscitation 2 (GO-FAR 2) score

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