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Prearrest predictio...
Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest : The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score.
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- Piscator, Eva (author)
- Karolinska Institutet,Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna, Karolinska University Hospital
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- Göransson, Katarina, 1974- (author)
- Karolinska Institutet,Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine, Karolinska University Hospital,Karolinska Institutet, Stockholm, Sweden
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- Forsberg, Sune (author)
- Karolinska Institutet,Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Department of Anaesthesiology and Intensive Care
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- Bottai, Matteo (author)
- Karolinska Institutet,Unit of Biostatistics, Department of Environmental Medicine (IMM), Karolinska Institutet
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- Ebell, Mark (author)
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia
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- Herlitz, Johan, 1949- (author)
- Gothenburg University,Göteborgs universitet,Högskolan i Borås,Akademin för vård, arbetsliv och välfärd,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Prehospen
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- Djärv, Therese (author)
- Karolinska Institutet,Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna
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(creator_code:org_t)
- Elsevier BV, 2019
- 2019
- English.
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 143, s. 92-99
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Abstract
Subject headings
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- BACKGROUND: 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.METHODS: 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%).RESULTS: 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%).CONCLUSION: 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Cardiopulmonary resuscitation
- Clinical decision-making
- Heart arrest
- In-hospital cardiac arrest
- Medical futility
- Models-Statistical
- Prognosis
- Människan i vården
- Människan i vården
- Människan i vården
- Människan i vården
Publication and Content Type
- ref (subject category)
- art (subject category)
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