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Background <p>Risk stratification and determination of prognosis is important during out-of-hospital cardiac arrest (OHCA) in order to decide on termination or escalation of therapy.</p> Objective <p>To identify and compare scores which can be easily determined in the emergency department and which predict 30-day survival with good neurological result (defined as Cerebral Performance Score [CPC] of 1&#xa0;or&#xa0;2) after nontraumatic OHCA.</p> Materials and methods <p>We identified SWAP score, GRApH score, and a&#xa0;4-step model in a&#xa0;literature search. We calculated these scores as well as CaRdiac Arrest Survival Score (CRASS) in 570&#xa0;adult patients who were admitted to our hospital between January 2018 and May 2023 after nontraumatic OHCA and cardiopulmonary resuscitation (CPR). We compared area under the receiver–operator curve (AUROC), sensitivity, specificity, predictive values, and calibration in our cohort.</p> Results <p>The 30-day survival with CPC 1/2 was 15.4%. AUROC was comparable between all tests (CRASS 0.89 [95% confidence interval (CI) 0.85–0.92], SWAP 0.84 [95%CI 0.79–0.89], GRApH 0.84 [95%CI 0.79–0.89], 4‑step score 0.81 [95%CI 0.76–0.86]); only CRASS and 4‑step-model differed significantly (<i>p</i> &lt; 0.01). Positive predictive value was highest in the lowest stratum of the 4‑step model (97.7%) and the SWAP (100%); negative predictive value was highest in the highest stratum of GRApH (87.5%) and SWAP (70.8%).</p> Conclusion <p>There are well-validated scores for determination of prognosis during CPR. These can be used by emergency medical service or emergency department staff to make a&#xa0;transparent and objective decision on escalation or de-escalation of therapy in cardiac arrest.</p>

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Prognoseabschätzung bei Reanimation – Vergleich verfügbarer Scores

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月29日

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  • Tobias Gehringer,
  • Georg Stachel,
  • Lisa Ruft,
  • Karsten Lenk,
  • Dominik Michalski,
  • Joseph Classen,
  • Sirak Petros,
  • Sebastian Stehr,
  • Ulrich Laufs,
  • André Gries

摘要

Background

Risk stratification and determination of prognosis is important during out-of-hospital cardiac arrest (OHCA) in order to decide on termination or escalation of therapy.

Objective

To identify and compare scores which can be easily determined in the emergency department and which predict 30-day survival with good neurological result (defined as Cerebral Performance Score [CPC] of 1 or 2) after nontraumatic OHCA.

Materials and methods

We identified SWAP score, GRApH score, and a 4-step model in a literature search. We calculated these scores as well as CaRdiac Arrest Survival Score (CRASS) in 570 adult patients who were admitted to our hospital between January 2018 and May 2023 after nontraumatic OHCA and cardiopulmonary resuscitation (CPR). We compared area under the receiver–operator curve (AUROC), sensitivity, specificity, predictive values, and calibration in our cohort.

Results

The 30-day survival with CPC 1/2 was 15.4%. AUROC was comparable between all tests (CRASS 0.89 [95% confidence interval (CI) 0.85–0.92], SWAP 0.84 [95%CI 0.79–0.89], GRApH 0.84 [95%CI 0.79–0.89], 4‑step score 0.81 [95%CI 0.76–0.86]); only CRASS and 4‑step-model differed significantly (p < 0.01). Positive predictive value was highest in the lowest stratum of the 4‑step model (97.7%) and the SWAP (100%); negative predictive value was highest in the highest stratum of GRApH (87.5%) and SWAP (70.8%).

Conclusion

There are well-validated scores for determination of prognosis during CPR. These can be used by emergency medical service or emergency department staff to make a transparent and objective decision on escalation or de-escalation of therapy in cardiac arrest.