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Published on: October 24, 2020
Simultaneous external validation of various cardiac arrest prognostic scores: a single-center retrospective study
Takumi Tsuchida1, Kota Ono2, Kunihiko Maekawa1
1Department of Emergency Medicine, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
Insights
The NULL-PLEASE score demonstrates superior predictive ability for out-of-hospital cardiac arrest (OHCA) outcomes compared to other clinical scores. This score is particularly effective in predicting neurological outcomes in bystander-witnessed OHCA cases.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) prognosis is complex, with various scoring systems developed to predict patient outcomes.
- Existing scores like Cardiac Arrest Hospital Prognosis (CAHP), post-cardiac arrest syndrome for therapeutic hypothermia (CAST), and revised CAST (rCAST) have limitations in predicting outcomes in diverse OHCA populations.
- The NULL-PLEASE clinical score, incorporating factors like non-shockable rhythm, unwitnessed arrest, and extracardiac causes, requires validation against established scores.
Purpose of the Study:
- To compare and validate the predictive performance of the NULL-PLEASE clinical score against CAHP, CAST, and rCAST scores in adult OHCA patients.
- To assess the utility of these scores in predicting neurological outcomes following OHCA.
- To evaluate the effectiveness of the NULL-PLEASE score specifically in subgroups of OHCA patients, including those with bystander witnesses.
Main Methods:
- Retrospective analysis of 189 adult OHCA patients admitted between February 2015 and July 2018.
- Calculation of OHCA, CAHP, NULL-PLEASE clinical, CAST, and rCAST scores based on collected patient data.
- Evaluation of predictive abilities using receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC) and partial AUCs.
Main Results:
- The NULL-PLEASE score demonstrated a large area under the ROC curve across various OHCA patient groups.
- In patients with bystander-witnessed OHCA, the NULL-PLEASE score showed significant predictive power with high sensitivity and specificity (0.8-1.0).
- While predictive abilities were not significantly different between scores in some analyses, NULL-PLEASE consistently showed strong performance.
Conclusions:
- The NULL-PLEASE score possesses high and comprehensive predictive ability for outcomes in diverse OHCA patient populations.
- The NULL-PLEASE score is a valuable tool for predicting both good and poor neurological outcomes, especially in bystander-witnessed OHCA cases.
- This validated score can aid in clinical decision-making and prognostication for OHCA patients.
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.
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