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Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score
Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-4062-4470
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 128, p. 63-69Article in journal (Refereed) Published
Abstract [en]

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. 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. 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. 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.

Place, publisher, year, edition, pages
Elsevier B.V , 2018. Vol. 128, p. 63-69
Keywords [en]
Heart arrest ; Prognosis ; In-hospital cardiac arrest ; Clinical decision-making ; Cardiopulmonary resuscitation ; Medical futility ; Comorbidity ; Humans ; Middle Aged ; Male ; Cardiopulmonary Resuscitation ; Heart Arrest - mortality ; Decision Support Systems, Clinical - standards ; Aged, 80 and over ; Female ; ROC Curve ; Registries ; Aged ; Resuscitation Orders ; Retrospective Studies ; Heart Arrest - therapy ; Medical records ; Analysis ; Cardiac arrest ; Index Medicus ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Klinisk medicin ; Människan i vården ; Clinical Medicine ; Anestesi och intensivvård ; Anesthesiology and Intensive Care
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:du-37000DOI: 10.1016/j.resuscitation.2018.04.035OAI: oai:DiVA.org:du-37000DiVA, id: diva2:1556874
Available from: 2021-05-24 Created: 2021-05-24 Last updated: 2021-05-24Bibliographically approved

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Göransson, Katarina

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CiteExportLink to record
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Citation style
  • apa
  • ieee
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  • Other style
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  • nn-NB
  • sv-SE
  • Other locale
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Output format
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  • asciidoc
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