Simultaneous external validation of various cardiac arrest prognostic scores: a single-center retrospective study

Abstract

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 0.8–1.0 and specificity 0.8–1.0. 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.

Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study

“…The findings of this study are generally in line with previous validation studies evaluating outcomes at hospital discharge or 30 days post-event, where the CAHP score showed a slightly better performance than the OHCA score [ 29 , 30 , 33 , 48 ]. In two different cohorts of cardiac arrest patients evaluating outcomes at hospital discharge [ 49 ] or 90 days [ 32 ] the OHCA score performed somewhat better than the CAHP score.…”

Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance

“…Fifteen studies [ 13 , 31 , 32 , 34 , 35 , 50 – 59 ] reporting outcomes from 18 cohorts (ten prospective and eight retrospective cohorts) with a total of 4′747 patients were included in the review, of which 16 external validation cohorts [ 31 , 32 , 34 , 35 , 50 – 59 ] were available for the evaluation of the OHCA score’s prognostic performance. The studies were mainly performed in Europe ( n = 7) [ 13 , 35 , 50 , 52 , 54 , 56 , 60 ] and in Asia ( n = 6) [ 34 , 53 , 55 , 57 – 59 ] with one study each performed in the USA[ 31 ] and Australia [ 32 ], respectively. The majority of studies ( n = 11) [ 13 , 31 , 34 , 51 , 53 – 59 ] reported outcomes after OHCA, whereas three studies [ 32 , 35 , 50 ] reported outcomes of both OHCA and IHCA patients, and one study [ 52 ] reported outcomes after IHCA only.…”

“…The studies were mainly performed in Europe ( n = 7) [ 13 , 35 , 50 , 52 , 54 , 56 , 60 ] and in Asia ( n = 6) [ 34 , 53 , 55 , 57 – 59 ] with one study each performed in the USA[ 31 ] and Australia [ 32 ], respectively. The majority of studies ( n = 11) [ 13 , 31 , 34 , 51 , 53 – 59 ] reported outcomes after OHCA, whereas three studies [ 32 , 35 , 50 ] reported outcomes of both OHCA and IHCA patients, and one study [ 52 ] reported outcomes after IHCA only. In accordance with the original publication of the OHCA score [ 13 ], the majority of studies assessed the prognostic performance of the OHCA score for the prediction of neurological outcome ( n = 12) [ 13 , 31 , 34 , 35 , 51 – 55 , 57 – 59 ].…”

“…The majority of studies ( n = 11) [ 13 , 31 , 34 , 51 , 53 – 59 ] reported outcomes after OHCA, whereas three studies [ 32 , 35 , 50 ] reported outcomes of both OHCA and IHCA patients, and one study [ 52 ] reported outcomes after IHCA only. In accordance with the original publication of the OHCA score [ 13 ], the majority of studies assessed the prognostic performance of the OHCA score for the prediction of neurological outcome ( n = 12) [ 13 , 31 , 34 , 35 , 51 – 55 , 57 – 59 ]. In contrast, three studies[ 32 , 50 , 56 ] assessed the score’s performance in predicting mortality only.…”

“…In contrast, three studies[ 32 , 50 , 56 ] assessed the score’s performance in predicting mortality only. The outcome assessment was performed at hospital discharge or 30 days in 15 cohorts[ 13 , 31 , 32 , 34 , 35 , 50 – 57 , 59 ] and at > 1 month in three cohorts [ 54 , 58 ] (Box 1 ).…”