{"title":"在日本人群中简化院外心脏骤停和心脏骤停医院预后评分的外部验证:一项多中心回顾性队列研究","authors":"Keita Shibahashi, Kazuhiro Sugiyama, Yusuke Kuwahara, Takuto Ishida, Atsushi Sakurai, Nobuya Kitamura, Takashi Tagami, Taka-Aki Nakada, Munekazu Takeda, Yuichi Hamabe","doi":"10.1136/emermed-2020-210103","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.</p><p><strong>Methods: </strong>We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3-5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.</p><p><strong>Results: </strong>In total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ<sup>2</sup>=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ<sup>2</sup>=13.5 and Hosmer-Lemeshow test: p=0.10).</p><p><strong>Conclusion: </strong>The performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"124-131"},"PeriodicalIF":0.0000,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: a multicentre retrospective cohort study.\",\"authors\":\"Keita Shibahashi, Kazuhiro Sugiyama, Yusuke Kuwahara, Takuto Ishida, Atsushi Sakurai, Nobuya Kitamura, Takashi Tagami, Taka-Aki Nakada, Munekazu Takeda, Yuichi Hamabe\",\"doi\":\"10.1136/emermed-2020-210103\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.</p><p><strong>Methods: </strong>We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3-5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.</p><p><strong>Results: </strong>In total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ<sup>2</sup>=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ<sup>2</sup>=13.5 and Hosmer-Lemeshow test: p=0.10).</p><p><strong>Conclusion: </strong>The performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.</p>\",\"PeriodicalId\":410922,\"journal\":{\"name\":\"Emergency medicine journal : EMJ\",\"volume\":\" \",\"pages\":\"124-131\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Emergency medicine journal : EMJ\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/emermed-2020-210103\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/7/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency medicine journal : EMJ","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/emermed-2020-210103","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/7/21 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 3
摘要
背景:用于住院患者预后的新型简化院外心脏骤停(sOHCA)和简化心脏骤停住院预后(sCAHP)评分尚未得到外部验证。因此，本研究旨在从外部验证日本人群的sOHCA和sCAHP评分。方法:我们回顾性分析来自前瞻性维护的日本数据库(2012年1月至2013年3月)的数据。我们确定了在院外心脏骤停(OHCA)后复苏并住院的成年患者(n=2428，年龄≥18岁)。基于受试者工作特征曲线(auc)下面积的判别和校正测量以及Hosmer-Lemeshow拟合优度检验，我们分别参照原始评分对预测1个月不良神经预后(脑功能类别3-5)进行了验证。结果:共有1985/2484例(82%)患者出现1个月不良神经预后。原始OHCA、sOHCA、原始心脏骤停医院预后(CAHP)和sCAHP评分分别为855/2428(35%)、1359/2428(56%)、1130/2428(47%)和1834/2428(76%)患者。简化评分的AUC与原始评分的AUC差异无统计学意义，而sCAHP评分的AUC显著高于sOHCA评分(0.88 vs 0.81, p2=19.1, Hosmer-Lemeshow检验:p=0.014)，而sCAHP评分的AUC差异无统计学意义(ν=8， χ2=13.5, Hosmer-Lemeshow检验:p=0.10)。结论:原始和简化的OHCA和CAHP评分在预测成功复苏的OHCA患者的神经预后方面的表现是可以接受的。sCAHP评分具有最高的可得性、相似的判别性和良好的校准性，具有很好的临床应用潜力，尽管还需要进一步的验证研究来评估其临床可接受性。
External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: a multicentre retrospective cohort study.
Background: The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.
Methods: We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3-5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.
Results: In total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ2=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ2=13.5 and Hosmer-Lemeshow test: p=0.10).
Conclusion: The performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.
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