Department of Medicine, University of California San Diego, United States.
Division of Pulmonary and Critical Care Medicine, University of California San Diego, United States.
Resuscitation. 2019 Sep;142:69-73. doi: 10.1016/j.resuscitation.2019.07.006. Epub 2019 Jul 13.
Neurological status at hospital discharge is routinely used to assess patient outcome after cardiac arrest. However, attribution of impairment to the arrest is valid only if baseline neurological status is known. This study evaluated whether incorporating baseline neurological status improves performance of a widely employed neurological outcome scale for quantifying arrest-attributable morbidity.
Retrospective cohort study of two U.S. hospitals. Neurological function was assessed via Cerebral performance category (CPC), an ordinal five-point scale with 1 indicating sufficient cognition to lead an independent life and 5 representing brain death. Hospitalized adult patients who suffered in-hospital cardiac arrest for which cardiopulmonary resuscitation was attempted between 2011-2015 were included. Patients were identified through a quality improvement registry that captures all inpatient arrests in the two hospitals.
Of 486 patients who suffered in-hospital cardiac arrest, 124 (25.5%) had baseline abnormal neurological function (pre-hospitalization CPC>1). Although 54 patients had a normal discharge CPC of 1, 80 patients had no change in CPC from their prior baseline (11.1% vs. 16.5% met criterion for "normal" outcome defined as CPC of 1 vs. change-in-CPC of 0; McNemar p < .01; kappa for agreement: .78, 95% CI .69-.86). Across several formulations of criteria for "good" neurological outcome, similar discordance existed between conventional definitions considering only discharge CPC and modified definitions that included change-in-CPC from baseline.
Incorporating change-in-CPC into criteria for "good" neurological outcome post-arrest yields discordant results from traditional approaches that consider discharge CPC only and increases face validity of reporting arrest-related morbidity.
在医院出院时的神经状态通常用于评估心脏骤停后患者的预后。然而，只有在了解基线神经状态的情况下，才能将损害归因于心脏骤停。本研究评估了在广泛使用的神经预后量表中纳入基线神经状态是否可以提高评估心脏骤停相关发病率的性能。
这是一项在美国的两家医院进行的回顾性队列研究。通过脑功能分类（Cerebral performance category，CPC）评估神经功能，这是一个五分量表，1 表示认知功能充足，可以独立生活，5 表示脑死亡。纳入 2011-2015 年期间在医院发生心脏骤停且尝试心肺复苏的成年住院患者。通过质量改进登记册识别患者，该登记册可捕获两家医院所有住院患者的心脏骤停事件。
在 486 例发生院内心脏骤停的患者中，有 124 例（25.5%）基线神经功能异常（入院前 CPC>1）。尽管有 54 例患者出院时 CPC 正常为 1，但仍有 80 例患者的 CPC 与基线时无变化（11.1%与 16.5%符合“正常”结局的标准，即 CPC 为 1 与 CPC 变化为 0；McNemar p<.01；一致性kappa值：.78，95%CI：.69-.86）。在几种“良好”神经预后标准的制定中，仅考虑出院时 CPC 的传统定义与包括基线时 CPC 变化的修改定义之间存在不一致。
将 CPC 变化纳入心脏骤停后“良好”神经预后的标准会导致与仅考虑出院时 CPC 的传统方法产生不一致的结果，并提高报告与心脏骤停相关发病率的表面有效性。
