Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation

Mark H. Ebell, Woncheol Jang, Ye Shen, Romergryko G. Geocadin

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

IMPORTANCE: Informing patients and providers of the likelihood of survival after in-hospital cardiac arrest (IHCA), neurologically intact or with minimal deficits, may be useful when discussing do-not-attempt-resuscitation orders. OBJECTIVE: To develop a simple prearrest point score that can identify patients unlikely to survive IHCA, neurologically intact or with minimal deficits. DESIGN, SETTING, AND PARTICIPANTS: The study included 51 240 inpatients experiencing an index episode of IHCA between January 1, 2007, and December 31, 2009, in 366 hospitals participating in the Get With the Guidelines- Resuscitation registry. Dividing data into training (44.4%), test (22.2%), and validation (33.4%) data sets, we used multivariate methods to select the best independent predictors of good neurologic outcome, created a series of candidate decision models, and used the test data set to select the model that best classified patients as having a very low (<1%), low (1%-3%), average (>3%-15%), or higher than average (>15%) likelihood of survival after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status. The final model was evaluated using the validation data set. MAIN OUTCOMES AND MEASURES: Survival to discharge after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status (neurologically intact or with minimal deficits) based on a Cerebral Performance Category score of 1. RESULTS: The best performing model was a simple point score based on 13 prearrest variables. The C statistic was 0.78 when applied to the validation set. It identified the likelihood of a good outcome as very low in 9.4%of patients (good outcome in 0.9%), low in 18.9%(good outcome in 1.7%), average in 54.0% (good outcome in 9.4%), and above average in 17.7%(good outcome in 27.5%). Overall, the score can identify more than one-quarter of patients as having a low or very low likelihood of survival to discharge, neurologically intact or with minimal deficits after IHCA (good outcome in 1.4%). CONCLUSIONS AND RELEVANCE: The Good Outcome Following Attempted Resuscitation (GO-FAR) scoring system identifies patients who are unlikely to benefit from a resuscitation attempt should they experience IHCA. This information can be used as part of a shared decision regarding do-not-attempt-resuscitation orders.

Original languageEnglish (US)
Pages (from-to)1872-1878
Number of pages7
JournalJAMA Internal Medicine
Volume173
Issue number20
DOIs
StatePublished - Nov 11 2013

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Cardiopulmonary Resuscitation
Resuscitation
Heart Arrest
Survival
Resuscitation Orders
Nervous System
Registries
Inpatients
Guidelines

ASJC Scopus subject areas

  • Internal Medicine

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Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. / Ebell, Mark H.; Jang, Woncheol; Shen, Ye; Geocadin, Romergryko G.

In: JAMA Internal Medicine, Vol. 173, No. 20, 11.11.2013, p. 1872-1878.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: Informing patients and providers of the likelihood of survival after in-hospital cardiac arrest (IHCA), neurologically intact or with minimal deficits, may be useful when discussing do-not-attempt-resuscitation orders. OBJECTIVE: To develop a simple prearrest point score that can identify patients unlikely to survive IHCA, neurologically intact or with minimal deficits. DESIGN, SETTING, AND PARTICIPANTS: The study included 51 240 inpatients experiencing an index episode of IHCA between January 1, 2007, and December 31, 2009, in 366 hospitals participating in the Get With the Guidelines- Resuscitation registry. Dividing data into training (44.4{\%}), test (22.2{\%}), and validation (33.4{\%}) data sets, we used multivariate methods to select the best independent predictors of good neurologic outcome, created a series of candidate decision models, and used the test data set to select the model that best classified patients as having a very low (<1{\%}), low (1{\%}-3{\%}), average (>3{\%}-15{\%}), or higher than average (>15{\%}) likelihood of survival after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status. The final model was evaluated using the validation data set. MAIN OUTCOMES AND MEASURES: Survival to discharge after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status (neurologically intact or with minimal deficits) based on a Cerebral Performance Category score of 1. RESULTS: The best performing model was a simple point score based on 13 prearrest variables. The C statistic was 0.78 when applied to the validation set. It identified the likelihood of a good outcome as very low in 9.4{\%}of patients (good outcome in 0.9{\%}), low in 18.9{\%}(good outcome in 1.7{\%}), average in 54.0{\%} (good outcome in 9.4{\%}), and above average in 17.7{\%}(good outcome in 27.5{\%}). Overall, the score can identify more than one-quarter of patients as having a low or very low likelihood of survival to discharge, neurologically intact or with minimal deficits after IHCA (good outcome in 1.4{\%}). CONCLUSIONS AND RELEVANCE: The Good Outcome Following Attempted Resuscitation (GO-FAR) scoring system identifies patients who are unlikely to benefit from a resuscitation attempt should they experience IHCA. This information can be used as part of a shared decision regarding do-not-attempt-resuscitation orders.",
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N2 - IMPORTANCE: Informing patients and providers of the likelihood of survival after in-hospital cardiac arrest (IHCA), neurologically intact or with minimal deficits, may be useful when discussing do-not-attempt-resuscitation orders. OBJECTIVE: To develop a simple prearrest point score that can identify patients unlikely to survive IHCA, neurologically intact or with minimal deficits. DESIGN, SETTING, AND PARTICIPANTS: The study included 51 240 inpatients experiencing an index episode of IHCA between January 1, 2007, and December 31, 2009, in 366 hospitals participating in the Get With the Guidelines- Resuscitation registry. Dividing data into training (44.4%), test (22.2%), and validation (33.4%) data sets, we used multivariate methods to select the best independent predictors of good neurologic outcome, created a series of candidate decision models, and used the test data set to select the model that best classified patients as having a very low (<1%), low (1%-3%), average (>3%-15%), or higher than average (>15%) likelihood of survival after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status. The final model was evaluated using the validation data set. MAIN OUTCOMES AND MEASURES: Survival to discharge after in-hospital cardiopulmonary resuscitation for IHCA with good neurologic status (neurologically intact or with minimal deficits) based on a Cerebral Performance Category score of 1. RESULTS: The best performing model was a simple point score based on 13 prearrest variables. The C statistic was 0.78 when applied to the validation set. It identified the likelihood of a good outcome as very low in 9.4%of patients (good outcome in 0.9%), low in 18.9%(good outcome in 1.7%), average in 54.0% (good outcome in 9.4%), and above average in 17.7%(good outcome in 27.5%). Overall, the score can identify more than one-quarter of patients as having a low or very low likelihood of survival to discharge, neurologically intact or with minimal deficits after IHCA (good outcome in 1.4%). CONCLUSIONS AND RELEVANCE: The Good Outcome Following Attempted Resuscitation (GO-FAR) scoring system identifies patients who are unlikely to benefit from a resuscitation attempt should they experience IHCA. This information can be used as part of a shared decision regarding do-not-attempt-resuscitation orders.

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