The Department of Medicine, University of Washington, (NE Pacific Street) Seattle 98195, USA.
Scand J Trauma Resusc Emerg Med. 2011 Jun 15;19:38. doi: 10.1186/1757-7241-19-38.
The Cerebral Performance Category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the inter- and intra-reviewer reliability of the CPC.
We undertook an investigation to assess the inter-reviewer and source document reliability of the CPC among a cohort of survivors from out-of-hospital ventricular fibrillation cardiac arrest (n = 131) in a large metropolitan area between November 1, 2003 and December 31, 2005. Subjects with a CPC of 1 or 2 were classified as favorable outcome and those with CPC 3 or greater were classified as unfavorable outcome. One abstractor first used the discharge summary alone to determine the CPC. All 3 abstractors independently reviewed the entire hospital record. Reliability was assessed by determining the proportion of determinations that agreed between abstractors and the respective kappa statistics. We also evaluated the implications for determining survival with favorable neurological outcome when survival to hospital discharge was 20% and 30%.
When the entire hospital record was used to determine CPC, favorable neurologic outcome (CPC 1 or 2) was recorded in 92% by abstractor 1, 89% by abstractor 2, and 74% by abstractor 3. Agreement was 96% (kappa = 0.78) between abstractors 1 and 2, 84% (kappa = 0.49) between abstractors 2 and 3, 82% (kappa = 0.38) between abstractors 1 and 3. The 3-way kappa was 0.50. Agreement was 90% (kappa = 0.71) between the discharge summary alone and the entire hospital record. If the results from review of the entire record are applied to a circumstance where survival to discharge is 20%, favorable neurologic status would occur in 18.4% for abstractor 1, 17.8% for abstractor 2, and 14.8% for abstractor 3. For survival to hospital discharge of 30%, favorable neurologic status would occur in 27.6% for abstractor 1, 26.7% for abstractor 2, and 22.2% for abstractor 3.
In this cohort study of survivors of out-of-hospital ventricular fibrillation cardiac arrest, the use of the CPC to classify favorable versus unfavorable neurological status at hospital discharge produced variable inter- and intra-reviewer agreement. The findings provide useful context to interpret outcome evaluations that report CPC.
脑功能预后评分（Cerebral Performance Category，CPC）广泛应用于研究和质量保证中，以评估心搏骤停后的神经功能预后。然而，CPC 的内部和外部审查者之间的可靠性知之甚少。
我们进行了一项调查，以评估 2003 年 11 月 1 日至 2005 年 12 月 31 日期间，在一个大都市地区，31 例院外室颤性心搏骤停（VFCA）幸存者的内部和外部审查者之间 CPC 的可靠性。CPC 为 1 或 2 的患者被归类为预后良好，CPC 为 3 或更高的患者被归类为预后不良。一名摘要者首先单独使用出院小结来确定 CPC。所有 3 名摘要者都独立审查了整个住院记录。通过确定摘要者之间的一致性比例和各自的kappa 统计数据来评估可靠性。我们还评估了当出院时存活率为 20%和 30%时，使用 CPC 来确定有良好神经预后的生存的意义。
当使用整个住院记录来确定 CPC 时，摘要者 1 记录了 92%的患者预后良好（CPC 1 或 2），摘要者 2 记录了 89%，摘要者 3 记录了 74%。摘要者 1 和 2 之间的一致性为 96%（kappa = 0.78），摘要者 2 和 3 之间的一致性为 84%（kappa = 0.49），摘要者 1 和 3 之间的一致性为 82%（kappa = 0.38）。3 方 kapp 值为 0.50。单独使用出院小结和整个住院记录之间的一致性为 90%（kappa = 0.71）。如果将整个记录审查的结果应用于出院时存活率为 20%的情况，那么摘要者 1 有 18.4%的患者神经功能良好，摘要者 2 有 17.8%的患者神经功能良好，摘要者 3 有 14.8%的患者神经功能良好。当出院时存活率为 30%时，摘要者 1 有 27.6%的患者神经功能良好，摘要者 2 有 26.7%的患者神经功能良好，摘要者 3 有 22.2%的患者神经功能良好。
在这项院外室颤性心搏骤停幸存者的队列研究中，使用 CPC 对出院时的神经功能预后进行有利或不利的分类，产生了内部和外部审查者之间的可变一致性。研究结果为解释报告 CPC 的预后评估提供了有用的背景信息。
