Related Experiment Video
Updated: Jun 2, 2026
Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest
Published on: January 5, 2018
Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac
Jon C Rittenberger1, Ketki Raina, Margo B Holm
1University of Pittsburgh, Department of Emergency Medicine, School of Medicine, PA 15261, United States. rittenbergerjc@upmc.edu
Insights
Cerebral Performance Category (CPC) and Modified Rankin Scale (mRS) show fair agreement, but differ from discharge disposition in assessing cardiac arrest outcomes. A new measure is needed for this patient group.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Cerebral Performance Category (CPC), Modified Rankin Scale (mRS), and discharge disposition are standard outcome measures post-cardiac arrest.
- This study evaluated the association between these commonly used outcome assessment tools.
Purpose of the Study:
- To test the association between CPC, mRS, and discharge disposition in cardiac arrest survivors.
- To assess the reliability of these measures when abstracted from patient charts.
Main Methods:
- A retrospective chart review of 211 cardiac arrest survivors discharged between 2006-2009.
- Outcome measures (CPC, mRS, discharge disposition) were abstracted, with inter-rater reliability assessed.
- Kendall's tau correlation coefficients were used to analyze relationships between measures.
Main Results:
- Inter-rater reliability for CPC and mRS abstraction was high (95.24%).
- "Good outcomes" varied significantly: 20% by CPC, 22% by mRS, and 61% by discharge disposition.
- Relationships were fair between CPC and mRS (tau 0.43) but poor between CPC/mRS and discharge disposition (tau 0.23-0.25).
Conclusions:
- CPC, mRS, and discharge disposition are reliably determined from charts.
- These measures provide substantially different estimates of "good outcome" post-cardiac arrest.
- A more tailored outcome measure is required for the post-cardiac arrest population.
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.
