Article Text

Download PDFPDF
Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting
  1. Wen-Chu Chiang1,
  2. Yu-Sheng Huang2,
  3. Shu-Hsien Hsu1,
  4. Anna Marie Chang3,
  5. Patrick Chow-In Ko1,
  6. Hui-Chih Wang1,
  7. Chih-Wei Yang1,
  8. Ming-Ju Hsieh1,
  9. Edward Pei-Chuan Huang1,
  10. Kah-Meng Chong1,
  11. Jen-Tang Sun4,
  12. Shey-Ying Chen1,
  13. Matthew Huei-Ming Ma1,5
  1. 1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
  3. 3Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
  4. 4Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  5. 5Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Taiwan
  1. Correspondence to Professor Matthew Huei-Ming Ma, Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Zhongzheng District, Taipei 100, Taiwan;{at}


Objective The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance.

Methods We analysed Utstein registry data for 2009–2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance.

Results A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4%) cases and asystole in 384 (43.0%). In-hospital mortality was 854 (95.6%) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95% CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506–0.616) although the AUC was similar when all four were combined (AUC 0.695, 95% CI 0.615 to 0.775). The specificity of the simplified rule was 100% (95% CI 88.8% to 100%) and positive predictive value 100% (95% CI 96.8% to 100%). The false positive value, false negative value and decreased rate of unnecessary transport were 0% (95% CI 0% to 3.2%), 94.8% (95% CI 92.9% to 96.2%) and 16.4% (95% CI 14.1% to 19.1%), respectively.

Conclusions The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.

  • cardiac arrest
  • emergency ambulance systems
  • Trauma
  • resuscitation
  • emergency departments

Statistics from


  • Contributors W-CC, Y-SH and S-HH conceived the study, designed the trial and obtained research funding. MH-MM and PC-IK supervised the data collection. MH-MM, AMC and S-YC provided statistical advice on data analysis. H-CW, C-WT, M-JH, J-TS and EP-CH provided informative suggestions in preparation of the manuscript. W-CC and Y-SH drafted the manuscript. All authors contributed substantially to its revision. W-CC takes responsibility for the paper as a whole.

  • Funding This study was funded by Taiwan Ministry of Science and Technology (MOST 103-2628-B-002-007-MY2 and 101-2314-B-002-120 -MY3).

  • Competing interests None declared.

  • Ethics approval National Taiwan University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.