Abstract 13485: An Improved Prediction Scoring System To Estimate Survival With Favorable Neurological Outcomes After Out-of-hospital Cardiac Arrest: Evidence From A Nationwide Population-based Cohort Study In Japan
Introduction: Information on probability of survival with favorable neurological outcomes after out-of-hospital cardiac arrest (OHCA) can be useful for physicians when deciding whether to withhold further resuscitation attempts or terminate on-going resuscitation immediately after patient arrival at the emergency department.
Hypothesis: We hypothesized that a prediction scoring system integrated with prehospital variables could identify patients who are unlikely to survive with a favorable neurological outcome.
Methods: We analyzed the records of 238,174 adult OHCA patients obtained from a prospectively recorded Japanese national Utstein-style database from 2011 to 2012. The primary endpoint was 1-month survival with favorable neurological outcomes (cerebral performance category [CPC] score, 1 or 2 [CPC 1-2]). We developed a prediction scoring system to estimate 1 month CPC 1-2 after OHCA by using 2011 data (n = 118,631) and validating it by using corresponding 2012 data (n = 119,543). We used multivariate methods to select the best independent predictors of 1 month CPC 1-2 and classified patients as having a very low (<1%), low (1%-5%), average (>5%-15%), or higher than average (>15%) probability of 1 month CPC 1-2.
Results: The rate of 1 month CPC 1-2 was 2.1% (n = 4,897). The best performing model was based on 3 prehospital variables: witness status (YES or NO), initial documented shockable rhythm (YES or NO), and age (categorized as 18 to 64, 65 to 74, 75 to 84, or ≥85 years). The C statistic was 0.88 when applied to the validation set. It identified the probability of 1 month CPC 1-2 as very low, low, average, and above average in 70.3%, 23.0%, 3.3%, and 3.5% of patients, respectively (1 month CPC 1-2 in 0.4%, 2.2%, 11.3%, and 26.9% of patients, respectively). Overall, 90% of patients were identified as having a low or very low probability of 1 month CPC 1-2 after OHCA (1 month CPC 1-2 in 0.8% of patients).
Conclusions: Our prediction scoring system identifies OHCA patients who are unlikely to benefit from further resuscitation after arrival at the emergency department; this information can aid the decision regarding termination of resuscitation.
Author Disclosures: A. Funada: None. Y. Goto: None. T. Maeda: None. H. Tada: None. R. Teramoto: None. M. Shimojima: None. K. Hayashi: None. M. Yamagishi: None.
- © 2016 by American Heart Association, Inc.