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Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest: The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score.
Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna, Karolinska University Hospital.
Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine, Karolinska University Hospital.
Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Department of Anaesthesiology and Intensive Care.
Unit of Biostatistics, Department of Environmental Medicine (IMM), Karolinska Institutet.
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 92-99, article id S0300-9572(19)30568-4Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A prearrest prediction tool can aid clinicians in consolidating objective findings with clinical judgement and in balance with the values of the patient be a part of the decision process for do-not-attempt-resuscitation (DNAR) orders. A previous prearrest prediction tool for in-hospital cardiac arrest (IHCA) have not performed satisfactory in external validation in a Swedish cohort. Therefore our aim was to develop a prediction model for the Swedish setting.

METHODS: Model development was based on previous external validation of The Good Outcome Following Attempted Resuscitation (GO-FAR) score, with 717 adult IHCAs. It included redefinition and reduction of predictors, and addition of chronic comorbidity, to create a full model of 9 predictors. Outcome was favourable neurological survival defined as Cerebral Performance Category score 1-2  at discharge. The likelihood of favourable neurological survival was categorised into very low (<1%), low (1-3%) and above low (>3%).

RESULTS: We called the model the Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. The AUROC was 0.808 (95% CI 0.807-0.810) and calibration was satisfactory. With a cutoff of 3% likelihood of favourable neurological survival sensitivity was 99.4% and specificity 8.4%. Although specificity was limited, predictive value for classification into ≤3% likelihood of favorable neurological survival was high (97.4%) and false classification into ≤3% likelihood of favourable neurological survival was low (0.6%).

CONCLUSION: The PIHCA score has the potential to be used as an objective tool in prearrest prediction of outcome after IHCA, as part of the decision process for a DNAR order.

Place, publisher, year, edition, pages
2019. Vol. 143, p. 92-99, article id S0300-9572(19)30568-4
Keywords [en]
Cardiopulmonary resuscitation, Clinical decision-making, Heart arrest, In-hospital cardiac arrest, Medical futility, Models-Statistical, Prognosis
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården; Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-22155DOI: 10.1016/j.resuscitation.2019.08.010ISI: 000487197500014PubMedID: 31412292Scopus ID: 2-s2.0-85070979303OAI: oai:DiVA.org:hb-22155DiVA, id: diva2:1376458
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-19Bibliographically approved

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