Chiang Wen-Chu, Huang Yu-Sheng, Hsu Shu-Hsien, Chang Anna Marie, Ko Patrick Chow-In, Wang Hui-Chih, Yang Chih-Wei, Hsieh Ming-Ju, Huang Edward Pei-Chuan, Chong Kah-Meng, Sun Jen-Tang, Chen Shey-Ying, Ma Matthew Huei-Ming
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan.
Emerg Med J. 2017 Jan;34(1):39-45. doi: 10.1136/emermed-2014-204493. Epub 2016 Sep 21.
The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance.
We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance.
A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4%) cases and asystole in 384 (43.0%). In-hospital mortality was 854 (95.6%) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95% CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506-0.616) although the AUC was similar when all four were combined (AUC 0.695, 95% CI 0.615 to 0.775). The specificity of the simplified rule was 100% (95% CI 88.8% to 100%) and positive predictive value 100% (95% CI 96.8% to 100%). The false positive value, false negative value and decreased rate of unnecessary transport were 0% (95% CI 0% to 3.2%), 94.8% (95% CI 92.9% to 96.2%) and 16.4% (95% CI 14.1% to 19.1%), respectively.
The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.
2003年提出了创伤性心脏骤停（TCPA）的院前复苏终止（TOR）指南。其关于可终止复苏努力的多种病例描述使得该指南在现场应用起来很复杂。在此，我们提出了一条简化规则并评估了其预测性能。
我们分析了台北市紧急医疗服务机构2009 - 2013年的Utstein登记数据，以测试一条简化的TOR规则，该规则包含两个标准：钝性创伤和心搏停止。纳入对象为成年（≥18岁）TCPA患者。预测结局为院内死亡。我们将该简单规则的曲线下面积（AUC）与指南中的四个描述符分别以及四个描述符的组合进行比较，并评估它们的鉴别能力。计算检验特征以评估预测性能。
共纳入893例TCPA病例。钝性创伤发生于459例（51.4%），心搏停止发生于384例（43.0%）。院内死亡率为854例（95.6%）。与2003年指南中的任何单个描述符相比，简化的TOR规则具有更强的鉴别能力（AUC 0.683，95%CI 0.618至0.747），尽管四个描述符组合时的AUC与之相似（AUC 0.695，95%CI 0.615至0.775）。简化规则的特异性为100%（95%CI 88.8%至100%），阳性预测值为100%（95%CI 96.8%至100%）。假阳性值、假阴性值和不必要转运减少率分别为0%（95%CI 0%至3.2%）、94.8%（95%CI 92.9%至96.2%）和16.4%（95%CI 14.1%至19.1%）。
简化的TOR规则似乎能准确预测院前环境下成年TCPA患者中的非存活者。
