Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score

Eva Piscator, Katarina Göransson, Samuel Bruchfeld, Ulf Hammar, Sara el Gharbi, Mark H. Ebell, Johan Herlitz, Therese Djärv

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. Methods: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013–2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. Results: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78–0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. Conclusion: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalResuscitation
Volume128
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Heart Arrest
Resuscitation
Calibration
Survival
Cardiopulmonary Resuscitation
Registries
Resuscitation Orders
Physicians
Population

Keywords

  • Cardiopulmonary resuscitation
  • Clinical decision-making
  • Heart arrest
  • In-hospital cardiac arrest
  • Medical futility
  • Prognosis

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score. / Piscator, Eva; Göransson, Katarina; Bruchfeld, Samuel; Hammar, Ulf; el Gharbi, Sara; Ebell, Mark H.; Herlitz, Johan; Djärv, Therese.

In: Resuscitation, Vol. 128, 01.07.2018, p. 63-69.

Research output: Contribution to journalArticle

Piscator, Eva ; Göransson, Katarina ; Bruchfeld, Samuel ; Hammar, Ulf ; el Gharbi, Sara ; Ebell, Mark H. ; Herlitz, Johan ; Djärv, Therese. / Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score. In: Resuscitation. 2018 ; Vol. 128. pp. 63-69.
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AU - Piscator, Eva

AU - Göransson, Katarina

AU - Bruchfeld, Samuel

AU - Hammar, Ulf

AU - el Gharbi, Sara

AU - Ebell, Mark H.

AU - Herlitz, Johan

AU - Djärv, Therese

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N2 - Background: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. Methods: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013–2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. Results: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78–0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. Conclusion: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

AB - Background: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. Methods: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013–2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. Results: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78–0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. Conclusion: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

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