Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Emergency Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Crit Care Med. 2022 Mar 1;50(3):428-439. doi: 10.1097/CCM.0000000000005266.
Although several risk factors for outcomes of out-of-hospital cardiac arrest patients have been identified, the cumulative risk of their combinations is not thoroughly clear, especially after targeted temperature management. Therefore, we aimed to develop a risk score to evaluate individual out-of-hospital cardiac arrest patient risk at early admission after targeted temperature management regarding poor neurologic status at discharge.
Retrospective observational cohort study.
Two large academic medical networks in the United States.
Out-of-hospital cardiac arrest survivors treated with targeted temperature management with age of 18 years old or older.
None.
Based on the odds ratios, five identified variables (initial nonShockable rhythm, Leucocyte count < 4 or > 12 K/μL after targeted temperature management, total Adrenalin [epinephrine] ≥ 5 mg, lack of oNlooker cardiopulmonary resuscitation, and Time duration of resuscitation ≥ 20 min) were assigned weighted points. The sum of the points was the total risk score known as the SLANT score (range 0-21 points) for each patient. Based on our risk prediction scores, patients were divided into three risk categories as moderate-risk group (0-7), high-risk group (8-14), and very high-risk group (15-21). Both the ability of our risk score to predict the rates of poor neurologic outcomes at discharge and in-hospital mortality were significant under the Cochran-Armitage trend test (p < 0.001 and p < 0.001, respectively).
The risk of poor neurologic outcomes and in-hospital mortality of out-of-hospital cardiac arrest survivors after targeted temperature management is easily assessed using a risk score model derived using the readily available information. Its clinical utility needed further investigation.
尽管已经确定了一些与院外心脏骤停患者结局相关的危险因素，但它们组合的累积风险尚不清楚，尤其是在目标温度管理之后。因此，我们旨在开发一种风险评分系统，以评估在目标温度管理后早期入院的个体院外心脏骤停患者在出院时神经功能不良的风险。
回顾性观察性队列研究。
美国两个大型学术医疗网络。
接受目标温度管理治疗的院外心脏骤停幸存者，年龄在 18 岁及以上。
无。
基于比值比，确定了五个变量（初始非休克节律、目标温度管理后白细胞计数<4 或>12 K/μL、总肾上腺素[肾上腺素]≥5 mg、缺乏旁观者心肺复苏和复苏时间≥20 分钟），并为每个变量分配了加权分数。这些分数的总和即为每个患者的总风险评分，称为 SLANT 评分（范围 0-21 分）。根据我们的风险预测评分，患者被分为三个风险类别：中危组（0-7 分）、高危组（8-14 分）和极高危组（15-21 分）。我们的风险评分在预测出院时神经功能不良结局和院内死亡率方面的能力均在 Cochran-Armitage 趋势检验下具有显著意义（p<0.001 和 p<0.001，分别）。
使用易于获取的信息构建风险评分模型，可轻松评估目标温度管理后院外心脏骤停幸存者神经功能不良结局和院内死亡率的风险。其临床实用性需要进一步研究。
