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Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team
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Harrison, David A., Patel, Krishna, Nixon, Edel, Soar, Jasmeet, Smith, Gary B., Gwinnutt, Carl, Nolan, Jerry P. and Rowan, Kathryn M. (2014) Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation, 85 (8). pp. 993-1000. doi:10.1016/j.resuscitation.2014.05.004 ISSN 0300-9572.
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Official URL: http://dx.doi.org/10.1016/j.resuscitation.2014.05....
Abstract
Aim
The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals.
Methods
Risk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20 min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy.
Results
22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC > 20 min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC > 20 min (c index 0.81 versus 0.72).
Conclusions
Validated risk models for ROSC > 20 min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||||||
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 resuscitation, Cardiac arrest -- Treatment, CPR (First aid) | ||||||||||||
Journal or Publication Title: | Resuscitation | ||||||||||||
Publisher: | Elsevier Ireland Ltd | ||||||||||||
ISSN: | 0300-9572 | ||||||||||||
Official Date: | August 2014 | ||||||||||||
Dates: |
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Volume: | 85 | ||||||||||||
Number: | 8 | ||||||||||||
Page Range: | pp. 993-1000 | ||||||||||||
DOI: | 10.1016/j.resuscitation.2014.05.004 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 6 February 2019 | ||||||||||||
Date of first compliant Open Access: | 7 February 2019 | ||||||||||||
RIOXX Funder/Project Grant: |
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