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Risk prediction models for out-of-hospital cardiac arrest outcomes in England
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OHCAO Collaborators (Including: Ji, Chen, Brown, Terry, Booth, Scott J., Hawkes, Claire, Nolan, Jerry P., Mapstone, James, Fothergill, Rachael T., Spaight, Robert, Black, Sarah and Perkins, Gavin D.). (2021) Risk prediction models for out-of-hospital cardiac arrest outcomes in England. European Heart Journal , 7 (2). pp. 198-207. doi:10.1093/ehjqcco/qcaa019 ISSN 1522-9645.
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Official URL: http://dx.doi.org/10.1093/ehjqcco/qcaa019
Abstract
Introduction
The Out-of-Hospital Cardiac Arrest (OHCA) Outcomes project is a national research registry. One of its aims is to explore sources of variation in OHCA survival outcomes. This study reports the development and validation of risk prediction models for return of spontaneous circulation (ROSC) at hospital handover and survival to hospital discharge.
Methods and results
The study included OHCA patients who were treated during 2014 and 2015 by emergency medical services (EMS) from 7 English National Health Service ambulance services. The 2014 data were used to identify important variables and to develop the risk prediction models, which were validated using the 2015 data. Model prediction was measured by area under the curve (AUC), Hosmer-Lemeshow test, Cox calibration regression and Brier score. All analyses were conducted using mixed effects logistic regression models. Important factors included age, gender, witness/bystander cardiopulmonary resuscitation (CPR) combined, aetiology and initial rhythm. Interaction effects between witness/bystander CPR with gender, aetiology and initial rhythm and between aetiology and initial rhythm were significant in both models. The survival model achieved better discrimination and overall accuracy compared with the ROSC model (AUC=0.86 vs 0.67, Brier score=0.072 vs 0.194, respectively). Calibration tests showed over- and under-estimation for the ROSC and survival models, respectively. A sensitivity analysis individually assessing Index of Multiple Deprivation scores and location in the final models substantially improved overall accuracy with inconsistent impact on discrimination.
Conclusion
Our risk prediction models identified and quantified important pre-EMS intervention factors determining survival outcomes in England. The survival model had excellent discrimination.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Cardiac arrest , Emergency medical services , Cardiac resuscitation | |||||||||
| Journal or Publication Title: | European Heart Journal | |||||||||
| Publisher: | Oxford University Press | |||||||||
| ISSN: | 1522-9645 | |||||||||
| Official Date: | April 2021 | |||||||||
| Dates: |
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| Volume: | 7 | |||||||||
| Number: | 2 | |||||||||
| Page Range: | pp. 198-207 | |||||||||
| DOI: | 10.1093/ehjqcco/qcaa019 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Reuse Statement (publisher, data, author rights): | This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal following peer review. The version of record [insert complete citation information here] is available online at: Chen Ji, Terry P Brown, Scott J Booth, Claire Hawkes, Jerry P Nolan, James Mapstone, Rachael T Fothergill, Robert Spaight, Sarah Black, Gavin D Perkins, OHCAO Collaborators, Risk Prediction Models for Out-of-Hospital Cardiac Arrest Outcomes in England, European Heart Journal - Quality of Care and Clinical Outcomes, , qcaa019. https://doi.org/10.1093/ehjqcco/qcaa019 | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| Date of first compliant deposit: | 16 March 2020 | |||||||||
| Date of first compliant Open Access: | 10 March 2021 | |||||||||
| RIOXX Funder/Project Grant: |
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