Background The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.
Methods We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3–5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.
Results In total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ2=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ2=13.5 and Hosmer-Lemeshow test: p=0.10).
Conclusion The performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.
- cardiac arrest
- intensive care
Data availability statement
Data are available upon reasonable request. Registry data are available with permission of the Kanto Regional Group of the Japanese Association for Acute Medicine.
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Handling editor Richard Body
Collaborators SOS-KANTO steering council: Yokohama City University Medical Center, Kanagawa, Japan (Naoto Morimura MD)
Nihon University School of Medicine, Tokyo Japan (Atsushi Sakurai MD) Nihon University Surugadai Hospital, Tokyo, Japan (Ken Nagao MD) Tokyo Women's Medical University Hospital, Tokyo, Japan (Arino Yaguchi MD) Nippon Medical School Hospital, Tokyo, Japan (Tagami Takashi MD) Japanese Redcross Maebashi Hospital, Gunma, Japan (Dai Miyazaki MD) National Disaster Medical Center, Tokyo, Japan (Tomoko Ogasawara MD) Keio University Hospital, Tokyo, Japan (Kei Hayashida MD, Masaru Suzuki MD)
Tokai University School of Medicine, Kanagawa, Japan (Mari Amino MD) Kimitsu Chuo Hospital, Chiba, Japan (Nobuya Kitamura MD) Juntendo University Nerima Hospital, Tokyo, Japan (Tomohisa Nomura MD) Tokyo Metropolitan Children's Medical Centre, Tokyo, Japan (Naoki Shimizu MD) Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan (Akiko Akashi MD).
National Cerebral and Cardiovascular Center Hospital (Yoshio Tahara MD) National Center of Neurology and Psychiatry (Naohiro Yonemoto MD) SOS-KANTO study group:Tokai University School of Medicine (Sadaki Inokuchi MD) St.Marianna University School of Medicine, Yokohama Seibu Hospital (Yoshihiro Masui MD) Koto Hospital (Kunihisa Miura MD) Saitama Medical Center Advanced Tertiary Medical Center (Haruhiko Tsutsumi MD) Kawasaki Municipal Hospital Emergency & Critical Care Center (Kiyotsugu Takuma MD) Yokohama Municipal Citizen's Hospital (Ishihara Atsushi MD) Japanese Redcross Maebashi Hospital (Minoru Nakano MD) Juntendo University Urayasu Hospital (Hiroshi Tanaka MD) Dokkyo Medical University Koshigaya Hospital (Keiichi Ikegami MD) Hachioji Medical Center of Tokyo Medical University (Takao Arai MD) Tokyo Women's Medical University Hospital (Arino Yaguchi MD) Kimitsu Chuo Hospital (Nobuya Kitamura MD) Chiba University Graduate School of Medicine (Shigeto Oda MD)
Saiseikai Utsunomiya Hospital (Kenji Kobayashi MD) Mito Saiseikai General Hospital (Takayuki Suda MD)
Dokkyo Medical University (Kazuyuki Ono MD) Yokohama City University Medical Center (Naoto Morimura MD) National Hospital Organization Yokohama Medical Center (Ryosuke Furuya MD) National Disaster Medical Center (Yuichi Koido MD)
Yamanashi Prefectural Central Hospital (Fumiaki Iwase MD) Surugadai Nihon University Hospital (Ken Nagao MD)
Yokohama Rosai Hospital (Shigeru Kanesaka MD) Showa General Hospital (Yasusei Okada MD)
Nippon Medical School Tamanagayama Hospital (Kyoko Unemoto MD) Tokyo Women's Medical University Yachiyo Medical Center (Tomohito Sadahiro MD) Awa regional medical center (Masayuki Iyanaga MD) Todachuo General Hospital (Asaki Muraoka MD)
Japanese Red Cross Medical Center (Munehiro Hayashi MD) St.Luke's International Hospital (Shinichi Ishimatsu MD)
Showa University School of Medicine (Yasufumi Miyake MD) Totsuka Kyoritsu Hospital 1 (Hideo Yokokawa MD)
St.Marianna University School of Medicine (Yasuaki Koyama MD) National Hospital Organization Mito Medical Center (Asuka Tsuchiya MD) Tokyo Metropolitan Tama Medical Center (Tetsuya Kashiyama MD) Showa University Fujigaoka Hospital (Munetaka Hayashi MD) Gunma University Graduate School of Medicine (Kiyohiro Oshima MD) Saitama Red Cross Hospital (Kazuya Kiyota MD) Tokyo Metropolitan Bokutoh Hospital (Yuichi Hamabe MD) Nippon Medical School Hospital (Hiroyuki Yokota MD)
Keio University Hospital (Shingo Hori MD) Chiba Emergency Medical Center (Shin Inaba MD) Teikyo University School of Medicine (Tetsuya Sakamoto MD) Japanese Red Cross Musashino Hospital (Naoshige Harada MD) National Center for Global Health and Medicine Hospital (Akio Kimura MD) Tokyo Metropolitan Police Hospital (Masayuki Kanai MD) Medical Hospital of Tokyo Medical and Dental University (Yasuhiro Otomo MD) Juntendo University Nerima Hospital (Manabu Sugita MD)
Nihon University School of Medicine (Kosaku Kinoshita MD) Toho University Ohashi Medical Center (Takatoshi Sakurai MD)
Saiseikai Yokohamashi Tobu Hospital (Mitsuhide Kitano MD) Noppn Medical School Musashikosugi Hospital (Kiyoshi fb MD)
Tokyo Rosai Hospital (Kotaro Tanaka MD) Toho university Omori medical center (Katsunori Yoshihara MD) Hiratsuka city Hospital (Kikuo Yoh MD) Yokosuka Kyosai Hospital (Junichi Suzuki MD) Saiseikai Yokohamashi Nambu Hospital (Hiroshi Toyoda MD)
Nippon Medical School Chiba Hokusoh Hospital (Kunihiro Mashiko MD) Tokyo Metropolitan Children's Medical Centre (Naoki Shimizu MD) National Medical Center for Children and Mothers (Takashi Muguruma MD) Chiba Aoba Municipal Hospital (Tadanaga Shimada MD) Kuki General Hospital (Yoshiro Kobe MD) Matsudo City Hospital (Tomohisa Shoko MD) Japanese Red Cross Narita Hospital (Kazuya Nakanishi MD) Tokyo Bay Urayasu/Ichikawa Medical Center (Takashi Shiga MD) NTT Medical Center Tokyo (Takefumi Yamamoto MD) Tokyo Saiseikai Central Hospital (Kazuhiko Sekine MD) Fuji Heavy Industries Health Insurance Society OTA Memorial Hopital (Shinichi Izuka MD)
Contributors KSh contributed to study conception and design, interpretation of data, statistical analysis, drafting of the manuscript and critical revision of the manuscript for important intellectual content and provided intellectual input into the research and the manuscript. AS, NK, TT and T-aN contributed to acquisition of data and critical revision of the manuscript for important intellectual content and provided intellectual input into the research and the manuscript. KSu, YK, TI and YH contributed to critical revision of the manuscript for important intellectual content and provided intellectual input into the research and the manuscript. All authors read and approved the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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