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Prehospital ABC (Age, Bystander and Cardiogram) scoring system to predict neurological outcomes of cardiopulmonary arrest on arrival: post hoc analysis of a multicentre prospective observational study
  1. Kazuyuki Uehara1,
  2. Takashi Tagami2,
  3. Hideya Hyodo1,
  4. Toshihiko Ohara1,
  5. Atsushi Sakurai3,
  6. Nobuya Kitamura4,
  7. Taka-aki Nakada5,
  8. Munekazu Takeda6,
  9. Hiroyuki Yokota7,
  10. Masahiro Yasutake1
  1. 1Department of General Medicine and Health Science, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
  2. 2Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi-kosugi Hospital, Kawasaki-shi, Kanagawa, Japan
  3. 3Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
  4. 4Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu-shi, Chiba, Japan
  5. 5Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba-shi, Chiba, Japan
  6. 6Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
  7. 7Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
  1. Correspondence to Dr Kazuyuki Uehara, Department of General Medicine and Health Science, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan; k-uehara{at}nms.ac.jp

Abstract

Background There is currently limited evidence to guide prehospital identification of patients with cardiopulmonary arrest on arrival (CPAOA) to hospital who have potentially favourable neurological function. This study aimed to develop a simple scoring system that can be determined at the contact point with emergency medical services to predict neurological outcomes.

Methods We analysed data from patients with CPAOA using a regional Japanese database (SOS-KANTO), from January 2012 to March 2013. Patients were randomly assigned into derivation and validation cohorts. Favourable neurological outcomes were defined as cerebral performance category 1 or 2. We developed a new scoring system using logistic regression analysis with the following predictors: age, no-flow time, initial cardiac rhythm and arrest place. The model was internally validated by assessing discrimination and calibration.

Results Among 4907 patients in the derivation cohort and 4908 patients in the validation cohort, the probabilities of favourable outcome were 0.9% and 0.8%, respectively. In the derivation cohort, age ≤70 years (OR 5.11; 95% CI 2.35 to 11.14), no-flow time ≤5 min (OR 4.06; 95% CI 2.06 to 8.01) and ventricular tachycardia or fibrillation as initial cardiac rhythm (OR 6.66; 95% CI 3.45 to 12.88) were identified as predictors of favourable outcome. The ABC score consisting of Age, information from Bystander and Cardiogram was created. The areas under the receiver operating characteristic curves of this score were 0.863 in the derivation and 0.885 in the validation cohorts. Positive likelihood ratios were 6.15 and 6.39 in patients with scores >2 points and were 11.06 and 17.75 in those with 3 points.

Conclusion The ABC score showed good accuracy for predicting favourable neurological outcomes in patients with CPAOA. This simple scoring system could potentially be used to select patients for extracorporeal cardiopulmonary resuscitation and minimise low-flow time.

  • clinical management
  • resuscitation
  • management
  • clinical management

Data availability statement

Data are available on reasonable request. If you are a member of the Kanto Regional Chapter of the Japanese Society of Emergency Medicine and have a reasonable research plan, you can use the SOS-KANTO 2012 dataset. For more information, see the following URL: http: // jaam-kanto.umin.ne.jp / sos_kanto.html.

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Data availability statement

Data are available on reasonable request. If you are a member of the Kanto Regional Chapter of the Japanese Society of Emergency Medicine and have a reasonable research plan, you can use the SOS-KANTO 2012 dataset. For more information, see the following URL: http: // jaam-kanto.umin.ne.jp / sos_kanto.html.

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Footnotes

  • Handling editor Richard Body

  • Twitter @kitaccm

  • Collaborators SOS-KANTO 2012 study group.

  • Contributors KU conceptualised the study. KU, TT, HY and MY designed the study. AS, NK, T-aN and MT (SOS-KANTO 2012 study group) supervised the trial and data collection. AS, NK, T-aN and MT also undertook the recruitment of patients from participating centres and managed the data, including quality control. HH, TO and MY provided high-performance computers for data analysis. KU analysed the data, and TT provided advice on study design and statistics. KU drafted the manuscript, and all authors contributed substantially to its revision. KU is responsible for this paper as a whole and acts as the article guarantor.

  • 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.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.