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 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.

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

“…This results in a time delay compared with the OHCA and CAHP scores, which require only parameters readily available on ICU admission. 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.…”

“…The severity-of-illness scores APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS II (Simplified Acute Physiology Score II) have been widely used in critical care research, and the required clinical and laboratory parameters are readily available for all post-cardiac-arrest patients [24,25]. All four scores were successfully validated for the prediction of short-term neurological outcomes and mortality [26][27][28][29][30][31][32][33][34][35]. However, these scores have not been evaluated regarding long-term outcomes.…”

Combination of Cerebral Computed Tomography and Simplified Cardiac Arrest Hospital Prognosis (sCAHP) Score for Predicting Neurological Recovery in Cardiac Arrest Survivors

“…A revised CAST score was proposed in which the calculation is simplified through the deletion of three of the eight CAST factors: GWR, albumin level, and hemoglobin level [26]. In a single-center retrospective study, the two scores, with and without GWR, were compared, but no substantial differences were noted in the prognostic value of the two scores [27]. Limited evidence is available to indicate whether GWR still plays a crucial role in overall interpretation in addition to severity score for the neuroprognostication.…”