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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
Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-4062-4470
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, p. 92-99Article in journal (Refereed) Published
Abstract [en]

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. 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%). 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%). 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
Elsevier B.V , 2019. Vol. 143, p. 92-99
Keywords [en]
Heart arrest ; Prognosis ; In-hospital cardiac arrest ; Cardiopulmonary resuscitation ; Models-Statistical ; Medical futility ; Clinical decision-making ; Kardiologi ; Cardiac and Cardiovascular Systems ; Medicin och hälsovetenskap
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:du-36999DOI: 10.1016/j.resuscitation.2019.08.010OAI: oai:DiVA.org:du-36999DiVA, id: diva2:1556881
Available from: 2021-05-24 Created: 2021-05-24 Last updated: 2021-05-24Bibliographically approved

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