Wu Jun-Zuo, Chiu Wei-Che, Wu Wei-Ting, Chiu I-Min, Huang Kuo-Chen, Hung Chih-Wei, Cheng Fu-Jen
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan.
Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
Healthcare (Basel). 2022 Mar 20;10(3):578. doi: 10.3390/healthcare10030578.
Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients (>17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61−0.80, p < 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68−0.86, p < 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9−71.9%), 66.7.0% specificity (95% CI, 48.2−82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6−94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4−33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2−75.5%), 80.6% specificity (95% CI, 62.5−92.6%), 94.6% PPV (95% CI, 88.6%−98.0%), and 33.8% NPV (95% CI, 23.2−45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application.
背景。鉴于院外心脏骤停（OHCA）预后较差，它对急诊医生来说仍是一项挑战。2020年，建立了一种新的且更易于应用的MIRACLE2评分，用于预测OHCA的神经学转归。目的。本研究旨在比较MIRACLE2评分与心脏骤停医院预后（CAHP）评分对OHCA神经学转归的判别能力。方法。本回顾性队列研究于2015年1月至2019年12月进行。纳入由紧急医疗服务人员送往医院的成年心脏骤停患者（年龄>17岁）。因创伤、烧伤、溺水导致的死亡，因预先下达的“不要复苏”医嘱而未开始复苏的情况，以及未实现自主循环恢复的患者被排除。采用Youden指数进行受试者工作特征曲线分析，以计算两种评分的最佳截断值。结果。总体而言，分析了200例成年OHCA病例。MIRACLE2评分中神经学转归良好的阈值为5.5，曲线下面积（AUC）值为0.70（0.61 - 0.80，p < 0.001）；CAHP评分的阈值为223.4，AUC为0.77（0.68 - 0.86，p < 0.001）。设定MIRACLE2评分截断值时，我们记录到敏感性为64.7%（95%置信区间[CI]，56.9 - 71.9%），特异性为66.7.0%（95% CI，48.2 - 82.0%），阳性预测值（PPV）为90.8%（95% CI，85.6 - 94.2%），阴性预测值（NPV）为27.2%（95% CI，21.4 - 33.9%）。设定CAHP截断值时，我们观察到对于神经学转归不良的情况，敏感性为68.2%（95% CI，60.2 - 75.5%），特异性为80.6%（95% CI，62.5 - 92.6%），PPV为94.6%（95% CI，88.6% - 98.0%），NPV为33.8%（95% CI，23.2 - 45.7%）。结论。CAHP评分显示出比MIRACLE2评分更好的判别能力，并具有更高的敏感性、特异性、PPV和NPV；然而，CAHP评分的应用仍然相对困难。有必要进行进一步研究以建立判别能力更好且易于应用的评分。
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