External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management
External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management
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DOI：
10.1016/j.resuscitation.2019.05.028
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发表时间：
2019-07-01
期刊：
影响因子：
6.5
通讯作者：
Iwami, Taku
中科院分区：
文献类型：
--
作者：
Nishikimi, Mitsuaki;Ogura, Takayuki;Iwami, Taku
简介：对于在急诊室（艾德）接受目标体温管理（TTM）的心脏骤停后综合征（PCAS）患者，尚无确定的风险分类。本研究的目的是从外部验证我们的预后评分的简化版本，即“心脏骤停后综合征治疗性低温评分”。（revised CAST [rCAST]），并在此基础上估计风险分类的预测精度。对于外部验证，我们使用了来自日本急性医学协会（JAAM）的院外心脏骤停（OHCA）登记处的数据，这是一项针对日本OHCA患者的多中心前瞻性登记研究。合格患者为2014年6月至2015年12月期间在33-36 ℃下接受TTM治疗的PCAS患者。结果：在12,024例OHCA患者中，460例PCAS患者接受TTM治疗，其数据符合验证条件。rCAST预测30和90天时神经功能结局的曲线下面积分别为0.892和0.895。结果的风险类别的估计敏感性和特异性如下：0.95（95度0 CI：0.92-0.98）和0.47（0.40-0.55）低（rCAST：= 14.5）。rCAST对预测PCAS患者的神经功能结局具有较高的准确性，并且这三个等级是基于rCAST为风险分类开发的。
Introduction: There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score" (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it.Methods: For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33-36 C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days.Results: Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95 degrees 0 CI: 0.92-0.98) and 0.47 (0.40-0.55) for the low (rCAST: = 14.5).Conclusions: The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.