Grossestreuer Anne V, Abella Benjamin S, Sheak Kelsey R, Cinousis Marisa J, Perman Sarah M, Leary Marion, Wiebe Douglas J, Gaieski David F
Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Healthcare Economics, University of Pennsylvania, Philadelphia, PA, United States.
Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Resuscitation. 2016 Dec;109:21-24. doi: 10.1016/j.resuscitation.2016.09.006. Epub 2016 Sep 17.
Cerebral Performance Category (CPC) scores are often an outcome measure for post-arrest neurologic function, collected worldwide to compare performance, evaluate therapies, and formulate recommendations. At most institutions, no formal training is offered in their determination, potentially leading to misclassification.
We identified 171 patients at 2 hospitals between 5/10/2005 and 8/31/2012 with two CPC scores at hospital discharge recorded independently - in an in-house quality improvement database and as part of a national registry. Scores were abstracted retrospectively from the same electronic medical record by two separate non-clinical researchers. These scores were compared to assess inter-rater reliability and stratified based on whether the score was concordant or discordant among reviewers to determine factors related to discordance.
Thirty-nine CPC scores (22.8%) were discordant (kappa: 0.66), indicating substantial agreement. When dichotomized into "favorable" neurologic outcome (CPC 1-2)/"unfavorable" neurologic outcome (CPC 3-5), 20 (11.7%) scores were discordant (kappa: 0.70), also indicating substantial agreement. Patients discharged home (as opposed to nursing/other care facility) and patients with suspected cardiac etiology of arrest were statistically more likely to have concordant scores. For the quality improvement database, patients with discordant scores had a statistically higher median CPC score than those with concordant scores. The registry had statistically lower median CPC score (CPC 1) than the quality improvement database (CPC 2); p<0.01 for statistical significance.
CPC scores have substantial inter-rater reliability, which is reduced in patients who have worse outcomes, have a non-cardiac etiology of arrest, and are discharged to a location other than home.
脑功能表现类别（CPC）评分通常是心脏骤停后神经功能的一项结局指标，全球范围内均有收集，用于比较治疗效果、评估治疗方法并制定建议。在大多数机构中，在确定CPC评分时未提供正式培训，这可能导致分类错误。
我们在2005年5月10日至2012年8月31日期间，在两家医院确定了171例患者，其出院时的CPC评分在内部质量改进数据库和国家登记系统中独立记录。两名独立的非临床研究人员从同一电子病历中回顾性提取评分。比较这些评分以评估评分者间的可靠性，并根据评分在审阅者之间是否一致进行分层，以确定与不一致相关的因素。
39个CPC评分（22.8%）不一致（kappa值：0.66），表明一致性较高。当分为“良好”神经功能结局（CPC 1-2）/“不良”神经功能结局（CPC 3-5）时，20个（11.7%）评分不一致（kappa值：0.70），也表明一致性较高。出院回家（相对于护理/其他护理机构）的患者以及心脏骤停疑似病因的患者在统计学上更有可能获得一致的评分。对于质量改进数据库，评分不一致的患者的CPC评分中位数在统计学上高于评分一致的患者。登记系统的CPC评分中位数（CPC 1）在统计学上低于质量改进数据库（CPC 2）；差异具有统计学意义（p<0.01）。
CPC评分具有较高的评分者间可靠性，在结局较差、心脏骤停病因非心脏性且出院地点不是家的患者中，这种可靠性会降低。
