Resuscitation plus · 2026
Validation and comparison of two prearrest prediction scores for in-hospital cardiac arrest survival.
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Karim Hritul, Piscator Eva, Riva Gabriel, Ekvall Karl Oskar, Lauridsen Kasper G, Djärv Therese
Аннотация
BACKGROUND: The optimal pre-arrest prediction model for survival with favorable neurological outcomes following in-hospital cardiac arrest (IHCA) to aid Do-Not-Attempt-Cardiopulmonary-Resuscitation-decisions remains uncertain. This study aimed to externally validate the Prediction of Outcome for In-Hospital Cardiac Arrest (PIHCA) score and the Good Outcome Following Attempted Resuscitation (GO-FAR) 2 score and compare their performance for IHCA survival prediction.
METHOD: We collected data from IHCAs across three Swedish hospitals covering all care levels. We identified IHCAs through the Swedish Registry of Cardiopulmonary Resuscitation during 2015-2021 and extracted prediction model data through electronic medical records. Outcome measure was survival with favorable neurological survival defined as Cerebral Performance Category 1-2 at discharge, obtained from the registry. Prediction model performance was assessed with AUROC-curves (c-statistic), calibration coefficients and nonparametric calibration plots.
RESULTS: We identified 647 IHCAs of which 501 were eligible for inclusion. Overall, 28% had survival with favorable neurological outcome. AUROC for the PIHCA score was 0.73 (95% CI: 0.67-0.78), compared to 0.70 (95% CI: 0.65-0.75) for the GO-FAR 2 score. The 95% CI for difference of AUROC-score when PIHCA score was compared to GO-FAR 2 score was -0.01 to 0.06, i.e. not significant. The PIHCA score calibration coefficient was 0.69 (95% CI 0.51-0.88) compared to the GO FAR 2 score calibration coefficient of 1.02 (95% CI 0.73-1.34). The calibration plots were adequate for both scores, although with some degree of miscalibration at certain ranges for each model.
CONCLUSION: PIHCA score and the GO-FAR 2 score performed well and comparatively for prediction of survival with favorable neurological outcome following IHCA in a Swedish setting. Both scores could be considered for clinical use, in addition to sound clinical judgment, where the PIHCA score seems more adapted for clinical use.
METHOD: We collected data from IHCAs across three Swedish hospitals covering all care levels. We identified IHCAs through the Swedish Registry of Cardiopulmonary Resuscitation during 2015-2021 and extracted prediction model data through electronic medical records. Outcome measure was survival with favorable neurological survival defined as Cerebral Performance Category 1-2 at discharge, obtained from the registry. Prediction model performance was assessed with AUROC-curves (c-statistic), calibration coefficients and nonparametric calibration plots.
RESULTS: We identified 647 IHCAs of which 501 were eligible for inclusion. Overall, 28% had survival with favorable neurological outcome. AUROC for the PIHCA score was 0.73 (95% CI: 0.67-0.78), compared to 0.70 (95% CI: 0.65-0.75) for the GO-FAR 2 score. The 95% CI for difference of AUROC-score when PIHCA score was compared to GO-FAR 2 score was -0.01 to 0.06, i.e. not significant. The PIHCA score calibration coefficient was 0.69 (95% CI 0.51-0.88) compared to the GO FAR 2 score calibration coefficient of 1.02 (95% CI 0.73-1.34). The calibration plots were adequate for both scores, although with some degree of miscalibration at certain ranges for each model.
CONCLUSION: PIHCA score and the GO-FAR 2 score performed well and comparatively for prediction of survival with favorable neurological outcome following IHCA in a Swedish setting. Both scores could be considered for clinical use, in addition to sound clinical judgment, where the PIHCA score seems more adapted for clinical use.