Key result
In-hospital cardiac arrest risk models yield good discrimination for hospital survival with ~0.81 c-index.
Why the study?
To make fair comparisons among health care providers in the UK National Cardiac Arrest Audit, clinical indicators for in-hospital cardiac arrest require case mix adjustment using a validated risk model.
Cohort (n=22,479)
Yes
Answers are grounded in this paper and cite their sources.
Models with good discrimination may refine UK prognostication; extends GWTG-R but leaves open prospective validation and impact.
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 20min 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>20min 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>20min (c index 0.81 versus 0.72). CONCLUSIONS: Validated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement.
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Harrison et al. (2014) conducted a cohort in In-hospital cardiac arrest (n=22,479). NCAA risk prediction models (including age, sex, prior length of stay, reason for attendance, location of arrest, and presenting rhythm) was evaluated on Return of spontaneous circulation (ROSC) >20 min and survival to hospital discharge (c index 0.81 for hospital survival; c index 0.72 for ROSC >20 min). Risk prediction models for in-hospital cardiac arrest demonstrated good discrimination for hospital survival (c index 0.81) and acceptable discrimination for ROSC >20 min (c index 0.72).
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