Risk prediction models for out-of-hospital cardiac arrest outcomes in England.
Cardiac arrest
Emergency medical services
Out-of-hospital cardiac arrest
Predictive model
Resuscitation
Journal
European heart journal. Quality of care & clinical outcomes
ISSN: 2058-1742
Titre abrégé: Eur Heart J Qual Care Clin Outcomes
Pays: England
ID NLM: 101677796
Informations de publication
Date de publication:
15 03 2021
15 03 2021
Historique:
received:
16
12
2019
revised:
27
02
2020
accepted:
04
03
2020
pubmed:
11
3
2020
medline:
15
12
2021
entrez:
11
3
2020
Statut:
ppublish
Résumé
The out-of-hospital cardiac arrest (OHCA) outcomes project is a national research registry. One of its aims is to explore sources of variation in OHCA survival outcomes. This study reports the development and validation of risk prediction models for return of spontaneous circulation (ROSC) at hospital handover and survival to hospital discharge. The study included OHCA patients who were treated during 2014 and 2015 by emergency medical services (EMS) from seven English National Health Service ambulance services. The 2014 data were used to identify important variables and to develop the risk prediction models, which were validated using the 2015 data. Model prediction was measured by area under the curve (AUC), Hosmer-Lemeshow test, Cox calibration regression, and Brier score. All analyses were conducted using mixed-effects logistic regression models. Important factors included age, gender, witness/bystander cardiopulmonary resuscitation (CPR) combined, aetiology, and initial rhythm. Interaction effects between witness/bystander CPR with gender, aetiology and initial rhythm and between aetiology and initial rhythm were significant in both models. The survival model achieved better discrimination and overall accuracy compared with the ROSC model (AUC = 0.86 vs. 0.67, Brier score = 0.072 vs. 0.194, respectively). Calibration tests showed over- and under-estimation for the ROSC and survival models, respectively. A sensitivity analysis individually assessing Index of Multiple Deprivation scores and location in the final models substantially improved overall accuracy with inconsistent impact on discrimination. Our risk prediction models identified and quantified important pre-EMS intervention factors determining survival outcomes in England. The survival model had excellent discrimination.
Identifiants
pubmed: 32154865
pii: 5802469
doi: 10.1093/ehjqcco/qcaa019
pmc: PMC7962772
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
198-207Subventions
Organisme : British Heart Foundation
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Investigateurs
Theresa Foster
(T)
Frank Mersom
(F)
Gurkamal Francis
(G)
Michelle O'Rourke
(M)
Clare Bradley
(C)
Philip King
(P)
Patricia Bucher
(P)
Jessica Lynde
(J)
Jenny Lumley-Holmes
(J)
Julian Mark
(J)
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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