Kim Tae Han, Shin Sang Do, Kim Yu Jin, Kim Chu Hyun, Kim Jeong Eun
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2015 Jan;30(1):104-9. doi: 10.3346/jkms.2015.30.1.104. Epub 2014 Dec 23.
We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea.
我们使用韩国大城市紧急医疗服务(EMS)的院外心脏骤停(OHCA)数据,对基本生命支持复苏终止(BLS TOR)规则进行了回顾性验证。我们还通过调查补充BLS TOR规则的现场时间间隔对其进行了测试。使用了首尔的OHCA数据库(2011年1月至2012年12月),该数据库由救护车数据和医院病历审查组成。纳入了接受EMS治疗的OHCA患者以及19岁及以上的受害者,排除了发生在救护车上和信息不完整的病例。主要和次要结局分别是医院死亡率和不良神经结局。在计算敏感性(SS)、特异性(SP)以及阳性和阴性预测值(PPV和NPV)之后,根据现场时间间隔组对该规则进行测试以进行敏感性分析。在总共4835例分析患者中,3361例(69.5%)符合BLS TOR规则的所有3条标准。其中,322- (95.9%)在出院时死亡(SS,73.5%;SP,69.6%;PPV,95.9%;NPV,21.3%),3342例(99.4%)在出院时显示不良神经结局(SS,75.2%;SP,89.9%;PPV,99.4%;NPV,11.5%)。出院存活的100% SS和PPV的现场时间间隔临界值超过20分钟,良好神经功能恢复的现场时间间隔临界值超过14分钟。在韩国首尔的OHCA数据中,BLS TOR规则显示出相对较低的SS和PPV。